Provider Demographics
NPI:1770384596
Name:JIMENEZ CIRIACO, ELVIA DIVINA
Entity type:Individual
Prefix:
First Name:ELVIA
Middle Name:DIVINA
Last Name:JIMENEZ CIRIACO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 HOLLINS ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1042
Mailing Address - Country:US
Mailing Address - Phone:305-878-2639
Mailing Address - Fax:
Practice Address - Street 1:1454 MADISON AVE W FL 34142
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-2200
Practice Address - Country:US
Practice Address - Phone:239-658-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program