Basic Information
| Provider Information | |||||||||
| NPI: | 1598170706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ GONZALEZ | ||||||||
| FirstName: | ELAINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 KING STREET | ||||||||
| Address2: | THE PURCELL CLINIC, P.A. | ||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102767570 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL | ||||||||
| Address2: | PUERTO RICO MEDICAL CENTER | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 07/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 13458-I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 2017-00786 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.