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NPI Code Detail

MEDICARE: DR. JORGE R. DE JESUS M.D.

MEDICARE: DR. JORGE R. DE JESUS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician13959PR

General Provider Information

NPI Number : 1194721431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORGE R. DE JESUS M.D.
Provider Business Mailing Address
First Line : 282 CALLE MIRAMAR
Second Line :
City : MAYAGUEZ
State : PR
Zip : 00682-5836
Country : US
Telephone Number : 787-832-4116
Fax Number :
Provider Business Practice Location Address
First Line : 445 AVE GONZALEZ CLEMENTE
Second Line : STE 102
City : MAYAGUEZ
State : PR
Zip : 00682-1136
Country : US
Telephone Number : 787-450-7376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 07/27/2016

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