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General NPI Number Information
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NPI Number | 1710458674
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Entity Type | Individual
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Provider Name | FERMIN L DE JESUS MD
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | CARR 753 KM 6.4 BO YAUREL SECTOR PALMAREJO
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City | ARROYO
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State | PR
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Zip | 00714
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Country | US
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Telephone | 787-354-2907
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 6076
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City | ARROYO
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State | PR
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Zip | 00714-9607
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Country | US
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Telephone | 787-354-2907
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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 | 21180
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License Number State | PR
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