Provider Demographics
NPI:1013176031
Name:DEJESUS, PABLO MANUEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:MANUEL
Last Name:DEJESUS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:9 PINE CONE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8683
Mailing Address - Country:US
Mailing Address - Phone:386-445-6191
Mailing Address - Fax:
Practice Address - Street 1:PALM COAST FAMILY PRACTICE
Practice Address - Street 2:9 PINE CONE DRIVE, SUITE 102
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:386-445-6191
Practice Address - Fax:386-445-3916
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9114008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical