Healthcare Provider Details

I. General information

NPI: 1316860448
Provider Name (Legal Business Name): PAOLA ANDREA DE JESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1419
SAN GERMAN PR
00683-1419
US

IV. Provider business mailing address

URB. VILLAS DE FELISA 3042 CALLE MARIA LUISA ARCELAY
MAYAGUEZ PR
00680-7332
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-3333
  • Fax:
Mailing address:
  • Phone: 939-259-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8064
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: