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General NPI Number Information
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NPI Number | 1508473620
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Entity Type | Individual
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Provider Name | MARIA ISABEL DE JESUS MD
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Gender | Female
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | AVE ROBERTO CLEMENTE BLOQUE 124 NO. 8 VILLA CAROLINA
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City | CAROLINA
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State | PR
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Zip | 00985-0098
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Country | US
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Telephone | 407-732-3739
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Fax |
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Provider Business Mailing Address
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Address Line | 881 CALLE MANUEL GUERRA
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City | SAN JUAN
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State | PR
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Zip | 00924-2533
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Country | US
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Telephone | 787-750-6525
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 22007
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License Number State | PR
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