Provider Demographics
NPI:1326586546
Name:CORPORACION FONDO SEGURO ESTADO FAJARDO
Entity Type:Organization
Organization Name:CORPORACION FONDO SEGURO ESTADO FAJARDO
Other - Org Name:CFSE FAJARDO
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-793-5959
Mailing Address - Street 1:460 AVE MARCELITO GOTAY
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1207
Mailing Address - Country:US
Mailing Address - Phone:787-793-5959
Mailing Address - Fax:787-801-2900
Practice Address - Street 1:460 AVE MARCELITO GOTAY
Practice Address - Street 2:SECTOR EL BATEY
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-793-5959
Practice Address - Fax:787-801-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9607261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local