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General NPI Number Information
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NPI Number | 1407453095
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Entity Type | Individual
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Provider Name | DAVID M. DEJESUS
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Gender | Male
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | UBR PEREZ MORRIS 500 CALLE BAEZ
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City | SAN JUAN
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State | PR
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Zip | 00936-4189
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Country | US
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Telephone | 787-719-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CALLE NILO UBR BRISAS DEL PRADO
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City | JUNCOS
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State | PR
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Zip | 00777-9400
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Country | US
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Telephone | 787-590-6988
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23786
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License Number State | PR
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