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General NPI Number Information
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NPI Number | 1790989804
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Entity Type | Individual
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Provider Name | GINETTE ROSA DE JESUS PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | EDIF. SAN GERALDO SUITE 207G BO. TIERRA SANTA CARR. 149
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City | VILLALBA
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State | PR
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Zip | 00766
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Country | US
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Telephone | 787-847-6700
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Fax |
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Provider Business Mailing Address
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Address Line | LOS CAOBOS CALLE NOGAL # 2133
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City | PONCE
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State | PR
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Zip | 00716-2703
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Country | US
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Telephone | 787-633-6993
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1824
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License Number State | PR
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