1487196267 NPI number — CORPORACION FONDO 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 1487196267 NPI number — CORPORACION FONDO SEGURO DEL ESTADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPORACION FONDO 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:
6
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:
1487196267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 42006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00940-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-793-5959
Provider Business Mailing Address Fax Number:
787-767-4779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 838 KM 6.3 URB CARIBE SECTOR EL CINCO
Provider Second Line Business Practice Location Address:
CALLE PONCE DE LEON
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-793-5353
Provider Business Practice Location Address Fax Number:
787-767-4779
Provider Enumeration Date:
11/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ARANGO
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
RUBEN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
787-793-5959

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X , with the licence number:  10269 , 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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