Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 11043 | PR |
NPI | 1003873969 |
---|---|
Provider Name | Elena M De Jesus Pagan |
First Address | Toa Baja, PR 00949-4379 |
Second Address | Toa Baja, PR 00949-4106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5710 | IMC (01) | PR |
83411 | SSS (01) | PR |
9490009 | HUMANAPR (01) | PR |
F72193 | (02) | PR |