Provider Demographics
NPI:1215199260
Name:CORPORACION LA FONDITA DE JESUS
Entity Type:Organization
Organization Name:CORPORACION LA FONDITA DE JESUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CIENI
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:787-724-4051
Mailing Address - Street 1:MONSERRATE #704
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-1384
Mailing Address - Country:US
Mailing Address - Phone:787-724-4051
Mailing Address - Fax:
Practice Address - Street 1:704 CALLE MONSERRATE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4511
Practice Address - Country:US
Practice Address - Phone:787-724-4051
Practice Address - Fax:787-722-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health