Individual
LUIS DE JESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
3001 W DR MLK BLVD, TAMPA, FL 33607-6307
(813) 870-4000
Mailing address
2995 DREW ST, CLEARWATER, FL 33759-3012
(727) 315-7496
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
AA414
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022318900
—
FL
Enumeration date
08/16/2017
Last updated
01/18/2024
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