Individual
OTILIA DEJESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
265 BROOKVIEW CENTRE WAY STE 400, KNOXVILLE, TN 37919-4052
(800) 342-2898
Mailing address
14526 PLUMOSA DR, JACKSONVILLE BEACH, FL 32250-2222
(407) 375-9139
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME105497
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001415901
—
CT
Enumeration date
07/12/2006
Last updated
12/08/2024
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