1447685722 NPI number — MS. CARMEN ROXANA DE JESUS

Table of content: MS. CARMEN ROXANA DE JESUS (NPI 1447685722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447685722 NPI number — MS. CARMEN ROXANA DE JESUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE JESUS
Provider First Name:
CARMEN
Provider Middle Name:
ROXANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE JESUS
Provider Other First Name:
CARMEN
Provider Other Middle Name:
ROXANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447685722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BARBOSA 2021
Provider Second Line Business Mailing Address:
VILLA PALMERAS
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00912-4243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-636-0235
Provider Business Mailing Address Fax Number:
787-768-0565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BARBOSA 2021
Provider Second Line Business Practice Location Address:
VILLA PALMERAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-636-0235
Provider Business Practice Location Address Fax Number:
787-768-0565
Provider Enumeration Date:
09/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  5372 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5372 . This is a "STATE LICENCES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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