Healthcare Provider Details

I. General information

NPI: 1336780824
Provider Name (Legal Business Name): RAQUEL DE JESUS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 190
MAYAGUEZ PR
00681-0190
US

IV. Provider business mailing address

PO BOX 52104
TOA BAJA PR
00950-2104
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-5800
  • Fax:
Mailing address:
  • Phone: 787-224-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7789
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: