Healthcare Provider Details

I. General information

NPI: 1053394734
Provider Name (Legal Business Name): MYRIAM AMARO DE JESUS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 CALLE GUATEMALA URB LAS AMERICAS
SAN JUAN PR
00921-2308
US

IV. Provider business mailing address

783 CALLE GUATEMALA
SAN JUAN PR
00921-2360
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-6266
  • Fax: 787-292-0130
Mailing address:
  • Phone: 787-317-9770
  • Fax: 787-292-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12744
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: