Healthcare Provider Details

I. General information

NPI: 1770121154
Provider Name (Legal Business Name): ROBERTO ANDRES PALOU DE JESUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 MUNOZ RIVERA STE 1124
SAN JUAN PR
00918-4133
US

IV. Provider business mailing address

1300 HENDRICKS AVE APT 104
JACKSONVILLE FL
32207-8690
US

V. Phone/Fax

Practice location:
  • Phone: 787-499-6804
  • Fax:
Mailing address:
  • Phone: 787-529-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME173153
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME173153
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: