Provider Demographics
NPI:1285619114
Name:DE JESUS PLA, NILDA R
Entity type:Individual
Prefix:
First Name:NILDA
Middle Name:R
Last Name:DE JESUS PLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIF MEDICO SANTA CRUZ OFICINA 316
Mailing Address - Street 2:CALLE SANTA CRUZ #73
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6919
Mailing Address - Country:US
Mailing Address - Phone:787-787-8788
Mailing Address - Fax:787-787-4900
Practice Address - Street 1:EDIF MEDICO SANTA CRUZ OFICINA 316
Practice Address - Street 2:CALLE SANTA CRUZ #73
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6919
Practice Address - Country:US
Practice Address - Phone:787-787-8788
Practice Address - Fax:787-787-4900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6220071OtherHUMANA
067212OtherCRUZ AZUR
6220071OtherHUMANA
D95868Medicare UPIN