Provider Demographics
NPI:1043509623
Name:FERSAL PSC
Entity Type:Organization
Organization Name:FERSAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERNANDEZ CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-383-5859
Mailing Address - Street 1:CONDOMINIO SAN FRANCISCO JAVIER 50 CALLE SAN JOSE
Mailing Address - Street 2:APT 502
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-0000
Mailing Address - Country:US
Mailing Address - Phone:787-383-5859
Mailing Address - Fax:787-961-4524
Practice Address - Street 1:AVENIDA FONT MARTELO HOSPITAL HIMA HUMACAO
Practice Address - Street 2:NUM 3
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792-0000
Practice Address - Country:US
Practice Address - Phone:787-656-2424
Practice Address - Fax:787-961-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15819261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDP394ZMedicare PIN