| Doctor Name: | DR. MYRNA ENITH DEJESUS |
| NPI Number: | 1639186547 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 8868 |
| Business Practice Address: | X2 Ave Munoz Marin Caguas, PR - 007256431 |
| Business Phone Number: | 7877464610 |
| Business Fax Number: | 7877454030 |
| Mailing Address: | Po Box 304, GUAYNABO |
| State: | PR |
| Postal Code: | 009700304 |
| Phone Number: | 7877464610 |
| Fax Number: | 7877454030 |
| NPI Enumeration Date: | 08/02/2006 |
| NPI Last Update Date: | 10/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 8868 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |