1972704195 NPI number — CFSE

Table of content: MR. LEULSEGED GEBREKIDAN AMARE ARNP (NPI 1730802661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972704195 NPI number — CFSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CFSE
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:
1972704195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14522
Provider Second Line Business Mailing Address:
BO OBRERO STATION
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00916-4522
Provider Business Mailing Address Country Code:
US
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:
CFSE CARR #3, AVE. 65 INFANTERIA INTERSECCION CARR 887
Provider Second Line Business Practice Location Address:
BO. SAN ANTON
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00986-0858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-757-6850
Provider Business Practice Location Address Fax Number:
787-776-2252
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLAZ
Authorized Official First Name:
MARITA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
787-246-4176

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  13147 , 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)

  • Identifier: 13147 . This is a "STATE MEDICAL LICENSE NUM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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