Provider Demographics
NPI:1003873969
Name:DE JESUS PAGAN, ELENA M (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:M
Last Name:DE JESUS PAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8058 PLAZA GAVIOTAS
Mailing Address - Street 2:URB CAMINO DEL MAR
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4379
Mailing Address - Country:US
Mailing Address - Phone:787-795-3260
Mailing Address - Fax:787-795-1225
Practice Address - Street 1:2823 AVE DOS PALMAS
Practice Address - Street 2:URB. LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4106
Practice Address - Country:US
Practice Address - Phone:787-795-3260
Practice Address - Fax:787-795-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11043207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5710OtherIMC
PR83411OtherSSS
PR9490009OtherHUMANAPR
PR9490009OtherHUMANAPR
PR0611419OtherCRUZ AZUL
PR9490009OtherHUMANAPR