Provider Demographics
NPI:1407978307
Name:DEPARTAMENTO DE SALUD OFICIAL
Entity Type:Organization
Organization Name:DEPARTAMENTO DE SALUD OFICIAL
Other - Org Name:CPTET FAJARDO
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:DR
Authorized Official - First Name:CUIDUVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-765-2929
Mailing Address - Street 1:#100 URBANIZACION SANTA JUANITA
Mailing Address - Street 2:AVE LAUREL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4816
Mailing Address - Country:US
Mailing Address - Phone:787-765-2929
Mailing Address - Fax:787-863-5437
Practice Address - Street 1:HOSPITAL HIMMA SAN PABLO
Practice Address - Street 2:EDIFICIO CLINICAS EXTERNAS, SEGUNDO PISO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-765-2929
Practice Address - Fax:787-863-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4547-1OtherMEDICOS
PR660433481-11LOtherINTERNISTA
PR81459OtherMEDICO
PRS008OtherLABORATORIO
PRS078OtherINFECTOLOGO
PR004333CPTCOtherMED Y LAB
PR4547-3OtherLAB
PR600248OtherMED Y LAB
PR7400004OtherMED Y LAB
PR30346OtherLAB
PR101238OtherMED Y LAB
PR4547-5OtherESPECIALISTA
PR660433481-11TOtherPEDIATRA
PRS929OtherINTERNISTA
PR4547-1OtherMEDICOS