Provider Demographics
NPI:1366654097
Name:DE JESUS, PEDRO I
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:DE JESUS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCS 1344 HC-4
Mailing Address - Street 2:BOX 44374
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9606
Mailing Address - Country:US
Mailing Address - Phone:787-531-9518
Mailing Address - Fax:
Practice Address - Street 1:STREET 8 URB.VILLA SAURI
Practice Address - Street 2:M-16
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-531-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1065247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist