Provider Demographics
NPI:1851102420
Name:DE JESUS, VICTOR ALEXIS
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALEXIS
Last Name: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:HC 8 BOX 39273
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9442
Mailing Address - Country:US
Mailing Address - Phone:787-362-4519
Mailing Address - Fax:
Practice Address - Street 1:HC 8 BOX 39273
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9442
Practice Address - Country:US
Practice Address - Phone:787-362-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program