Provider Demographics
NPI:1013046218
Name:JIMENEZ, ELIZA M (MD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:M
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 141903
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1903
Mailing Address - Country:US
Mailing Address - Phone:787-593-9933
Mailing Address - Fax:787-544-6868
Practice Address - Street 1:CARR. #2 KM. 93.3
Practice Address - Street 2:BO. MEMBRILLO CAMINO LAS FLORES
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-544-6677
Practice Address - Fax:787-544-6868
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14453208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14553OtherLICENSE NUMBER