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General NPI Number Information
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NPI Number | 1124088224
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Entity Type | Individual
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Provider Name | MIGUEL A DE JESUS MD, FAAP
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 01/04/2012
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Provider Practice Location Address
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Address Line | COND ADA LIGIA LOCAL B OFICINA 4 AVE ASHFORD 1452
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City | SAN JUAN
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State | PR
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Zip | 00907-1581
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Country | US
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Telephone | 787-640-7111
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 1 #10 EXTENSION ALTURAS DE SAN PATRICIO
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City | GUAYNABO
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State | PR
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Zip | 00968
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Country | US
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Telephone | 787-725-0909
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Fax | 787-725-0909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5765
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License Number State | PR
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