Provider Demographics
NPI:1568346278
Name:DE JESUS, LUZ MARYANN
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:MARYANN
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:VILLA TURABO
Mailing Address - Street 2:L9 CALLE ROBLE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6150
Mailing Address - Country:US
Mailing Address - Phone:787-206-8453
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA ANDALUCIA
Practice Address - Street 2:AVE. FRONTERA H53
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-206-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1227224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant