Healthcare Provider Details

I. General information

NPI: 1205770906
Provider Name (Legal Business Name): ELSIE DE JESUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DRA. IRMA RUIZ PAGAN #901 URB BRISAS DEL MAR
LUQUILLO PR
00773
US

IV. Provider business mailing address

HC 1 BOX 11131
CAROLINA PR
00987-9659
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-4880
  • Fax: 787-889-8362
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number002153
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: