Provider Demographics
NPI:1790105476
Name:JARAMILLO GUTIERREZ DE ELLIOTT, HELEN ROSARIO (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:ROSARIO
Last Name:JARAMILLO GUTIERREZ DE ELLIOTT
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 1:4208 EVERGREEN LN STE 213
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3254
Mailing Address - Country:US
Mailing Address - Phone:703-642-7522
Mailing Address - Fax:
Practice Address - Street 1:4208 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3235
Practice Address - Country:US
Practice Address - Phone:703-642-7522
Practice Address - Fax:703-642-7565
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139108207V00000X
VA0101276143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103688700Medicaid
FLLO827OtherMEDICARE