IndividualActive
Adderly Toribio De Jesus, MD
NPI 1689235723 · Student in an Organized Health Care Education/Training Program · Providence, RI
Provider details
- NPI number
- 1689235723
- Entity type
- Individual
- Primary specialty
- Student in an Organized Health Care Education/Training ProgramStudent, Health Care
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- BP10090517 (TX)
Specialties & taxonomies
- Student in an Organized Health Care Education/Training ProgramPrimary390200000XLicense BP10090517 (TX)
Student, Health Care
Allopathic & Osteopathic Physicians
Practice location
825 Chalkstone Ave
Providence, RI 02908-4728
Phone: (401) 456-2000
Approximate (ZIP-level) locationGet directions
Mailing address
20 Hawthorne St Apt 2
Providence, RI 02907-2965
Registry dates
- Enumerated
- 2019-06-27
- Last updated
- 2024-06-26
- Certified
- 2024-06-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.