Individual provider Active NPI

Christine Marie Garcia de Jesus

  • Dentist
  • Ponce, PR
National Provider Identifier
1396206512
Registry record updated Oct 23, 2020
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Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3337 Issued in PR
Practice address
1034 Ave Hostos
Ponce, PR 00716-1115
Phone
(787) 843-9393
NPI assigned
Mar 29, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3337 PR Primary

Addresses

Primary practice location

1034 Ave Hostos
Ponce, PR 00716-1115

Mailing address

1034 Ave Hostos
Ponce, PR 00716-1115

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200615002354 PR Order and Referring Only - DentistPractitioner - Dentist 6901228220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3337PRMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1396206512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 AVE HOSTOS",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007161115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 AVE HOSTOS",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007161115",
            "telephone_number": "787-843-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA DE JESUS",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PR",
            "license": "3337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.