Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 14453 | PR |
NPI | 1013046218 |
---|---|
Provider Name | Eliza M Jimenez |
First Address | Hatillo, PR 00659-0907 |
Second Address | Hatillo, PR 00659-1847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14553 | LICENSE NUMBER (01) | PR |