Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 13875 | PR |
NPI | 1124007513 |
---|---|
Provider Name | Ricardo Luis Garcia-De Jesus |
First Address | San Juan, PR 00912-3310 |
Second Address | San Juan, PR 00912-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |