Healthcare Provider Details

I. General information

NPI: 1558459024
Provider Name (Legal Business Name): MARIA ANGELICA GOMEZ DE JESUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA BOULEVARD DEL RIO
HUMACAO PR
00791
US

IV. Provider business mailing address

PO BOX 24
PUNTA SANTIAGO PR
00741-0024
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-1400
  • Fax: 787-852-9020
Mailing address:
  • Phone: 787-405-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number9551
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: