Basic Information
| Provider Information | |||||||||
| NPI: | 1356540801 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEJESUS - GONZALEZ | ||||||||
| FirstName: | NILKA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29134 | ||||||||
| Address2: | NEFROLOGIA RCM | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009290134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877564010 | ||||||||
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| Practice Location | |||||||||
| Address1: | CLINICA DE LA ESCUELA DE MEDICINA | ||||||||
| Address2: | REPARTO METROPOLITANO SHOPPING | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877587910 | ||||||||
| FaxNumber: | 7876251966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2007 | ||||||||
| LastUpdateDate: | 08/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 17977 | PR | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0210X | 17977 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.