1013046218 NPI number — ELIZA M JIMENEZ M.D.

Table of content: ELIZA M JIMENEZ M.D. (NPI 1013046218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013046218 NPI number — ELIZA M JIMENEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JIMENEZ
Provider First Name:
ELIZA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013046218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 141903
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-593-9933
Provider Business Mailing Address Fax Number:
787-544-6868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. #2 KM. 93.3
Provider Second Line Business Practice Location Address:
BO. MEMBRILLO CAMINO LAS FLORES
Provider Business Practice Location Address City Name:
CAMUY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-544-6677
Provider Business Practice Location Address Fax Number:
787-544-6868
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  14453 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14553 . This is a "LICENSE NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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