1407149206 NPI number — CORP. FONDO DEL SEGURO DEL ESTADO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407149206 NPI number — CORP. FONDO DEL SEGURO DEL ESTADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORP. FONDO DEL SEGURO DEL ESTADO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407149206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
APARTADO #949, PONCE
Provider Second Line Business Mailing Address:
AVE. SANTIAGO DE LOS CABALLEROS #2136
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
P.R.
Provider Business Mailing Address Postal Code:
00733
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2136 AVE, SANTIAGO DE LOS CABALLEROS
Provider Second Line Business Practice Location Address:
APARATADO 949
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-848-4545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
MAYRA
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PHARMACY TECHNICIAN
Authorized Official Telephone Number:
787-848-4545

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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