=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205770906
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELSIE DE JESUS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2026
-----------------------------------------------------
Last Update Date | 04/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE DRA. IRMA RUIZ PAGAN #901 URB BRISAS DEL MAR
-----------------------------------------------------
City | LUQUILLO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-889-4880
-----------------------------------------------------
Fax | 787-889-8362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 1 BOX 11131
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987-9659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 002153
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------