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General NPI Number Information
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NPI Number | 1841493970
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Entity Type | Individual
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Provider Name | WILFREDO EUGENIO DE JESUS-MONGE M.D., M.SC.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 02/01/2009
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Provider Practice Location Address
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Address Line | 1693 CALLE CUERNAVACA VENUS GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00926-4649
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Country | US
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Telephone | 787-367-6983
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Fax |
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Provider Business Mailing Address
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Address Line | 1693 CALLE CUERNAVACA VENUS GARDENS
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City | SAN JUAN
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State | PR
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Zip | 00926-4649
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Country | US
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Telephone | 787-367-6983
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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 | 17025
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License Number State | PR
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