Provider Demographics
NPI:1770121154
Name:PALOU DE JESUS, ROBERTO ANDRES
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANDRES
Last Name:PALOU DE JESUS
Suffix:
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 1:1300 HENDRICKS AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8690
Mailing Address - Country:US
Mailing Address - Phone:787-529-3473
Mailing Address - Fax:
Practice Address - Street 1:654 MUNOZ RIVERA STE 1124
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4133
Practice Address - Country:US
Practice Address - Phone:787-499-6804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
FLME173153207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine