Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6043 | PR |
NPI | 1013569888 |
---|---|
Provider Name | Karla Beatriz De Jesus |
First Address | Carolina, PR 00987-2402 |
Second Address | Carolina, PR 00987-2402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 11/07/2019 |