Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 1750 | PR |
NPI | 1114923653 |
---|---|
Provider Name | Dr. Clara E De Jesus |
First Address | San Juan, PR 00924-4605 |
Second Address | San Juan, PR 00924-4605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |