Healthcare Provider Details

I. General information

NPI: 1508781154
Provider Name (Legal Business Name): JOSE DE JESUS DBA PASEOS MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 AVE, DONA FELISA RINCON DE GAUTIER SUITE 201
SAN JUAN PR
00926-6675
US

IV. Provider business mailing address

1341 CALLE ALDEA TH1
SAN JUAN PR
00907-2320
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-0080
  • Fax:
Mailing address:
  • Phone: 787-420-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE M. DE JESUS
Title or Position: PRESIDENT/OWNER
Credential: MD, OD
Phone: 787-420-0080