Provider Demographics
NPI:1053394734
Name:AMARO DE JESUS, MYRIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:
Last Name:AMARO DE JESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 CALLE GUATEMALA
Mailing Address - Street 2:URB LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2308
Mailing Address - Country:US
Mailing Address - Phone:787-281-6266
Mailing Address - Fax:787-292-0130
Practice Address - Street 1:783 CALLE GUATEMALA
Practice Address - Street 2:URB LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2308
Practice Address - Country:US
Practice Address - Phone:787-281-6266
Practice Address - Fax:787-292-0130
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12744207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12744OtherLICENCIA
PRBA58652627OtherDEA