Provider Demographics
NPI:1154534840
Name:DE JESUS, CECILIA (PHARMACY TECH)
Entity type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 20 BOX 21310
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9606
Mailing Address - Country:US
Mailing Address - Phone:787-704-2025
Mailing Address - Fax:787-704-2027
Practice Address - Street 1:HC 20 BOX 21310
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9606
Practice Address - Country:US
Practice Address - Phone:787-704-2025
Practice Address - Fax:787-704-2027
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3385183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician