Provider Demographics
NPI:1962424184
Name:DE JESUS, MARIGZA
Entity type:Individual
Prefix:
First Name:MARIGZA
Middle Name:
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:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0637
Mailing Address - Country:US
Mailing Address - Phone:787-349-1839
Mailing Address - Fax:787-732-1390
Practice Address - Street 1:31 CALLE RAFAEL LASA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3218
Practice Address - Country:US
Practice Address - Phone:787-732-3131
Practice Address - Fax:787-732-1390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist