Provider Demographics
NPI:1306556204
Name:DE JESUS, MARIE (TT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:TT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3215
Mailing Address - Country:US
Mailing Address - Phone:954-547-7180
Mailing Address - Fax:
Practice Address - Street 1:4801 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3215
Practice Address - Country:US
Practice Address - Phone:954-547-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care