Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | IMH5110 | FL |
NPI | 1245748276 |
---|---|
Provider Name | Dr. Gerardo De Jesus |
First Address | Orlando, FL 32837-5206 |
Second Address | Orlando, FL 32807-3536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 11/01/2018 |