Provider Demographics
NPI:1568215697
Name:ELIZALDE PADILLA, JAILENE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JAILENE
Middle Name:MARIE
Last Name:ELIZALDE PADILLA
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:HC 1 BOX 1396
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-9610
Mailing Address - Country:US
Mailing Address - Phone:787-218-3197
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 285
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0285
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health