Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 13621 | PR |
NPI | 1003981804 |
---|---|
Provider Name | Dr. Elena Maria Jimenez |
First Address | San Juan, PR 00917-5026 |
Second Address | San Juan, PR 00917-5026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 12/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23074 | PREFERRED (01) | |
62095 | BLUE CROSS (01) | |
9260093 | HUMANA (01) | |
H65276 | (02) |