Provider Demographics
NPI:1699272492
Name:DE JESUS, ERICA RAQUEL
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RAQUEL
Last Name:DE JESUS
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 1:507 W 186TH ST APT D4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2818
Mailing Address - Country:US
Mailing Address - Phone:646-399-5581
Mailing Address - Fax:
Practice Address - Street 1:507 W 186TH ST APT D4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2818
Practice Address - Country:US
Practice Address - Phone:646-399-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator