Provider Demographics
NPI:1407581440
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:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AGAPITO
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:787-988-7788
Practice Address - Street 1:CALLE MANUEL PIMENTEL Y CASTRO (CDT RIO GRANDE)
Practice Address - Street 2:200
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3000
Practice Address - Country:US
Practice Address - Phone:939-290-9093
Practice Address - Fax:787-988-7788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health