1407001829 NPI number — SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.

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 1407001829 NPI number — SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.
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:
1407001829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 827
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAJARDO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00738-0827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-863-7646
Provider Business Mailing Address Fax Number:
787-860-7357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
I24 CALLE PRINCIPAL
Provider Second Line Business Practice Location Address:
URB BARALT
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738-3772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-863-7646
Provider Business Practice Location Address Fax Number:
787-860-7357
Provider Enumeration Date:
11/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FONTANEZ
Authorized Official First Name:
AGAPITO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-863-7646

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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