Provider Demographics
NPI:1003981804
Name:JIMENEZ, ELENA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:MARIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 AVE PONCE DE LEON STE 503
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5026
Mailing Address - Country:US
Mailing Address - Phone:787-510-7880
Mailing Address - Fax:787-925-1200
Practice Address - Street 1:735 AVE PONCE DE LEON STE 503
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5026
Practice Address - Country:US
Practice Address - Phone:787-510-7880
Practice Address - Fax:787-925-1200
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
62095OtherBLUE CROSS
9260093OtherHUMANA
23074OtherPREFERRED
62095OtherBLUE CROSS
20996Medicare ID - Type Unspecified