Provider Demographics
NPI:1407001829
Name:SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGAPITO
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-863-7646
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0827
Mailing Address - Country:US
Mailing Address - Phone:787-863-7646
Mailing Address - Fax:787-860-7357
Practice Address - Street 1:I24 CALLE PRINCIPAL
Practice Address - Street 2:URB BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3772
Practice Address - Country:US
Practice Address - Phone:787-863-7646
Practice Address - Fax:787-860-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty