Provider Demographics
NPI:1407283716
Name:CORPORACION FONDO DEL SEGURO DEL ESTADO
Entity Type:Organization
Organization Name:CORPORACION FONDO DEL SEGURO DEL ESTADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNITHIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIRMA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SANCHEZ OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:2293
Authorized Official - Phone:787-854-2495
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-0799
Mailing Address - Country:US
Mailing Address - Phone:787-854-2495
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM. 48.3 INTERIOR
Practice Address - Street 2:URB ATENAS (DETRAS DEL CORREO FEDERAL)
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-2495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2293261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2293OtherPHARMACY TEC LIC