Provider Demographics
NPI:1487196267
Name:CORPORACION FONDO SEGURO DEL ESTADO
Entity Type:Organization
Organization Name:CORPORACION FONDO SEGURO DEL ESTADO
Other - Org Name:CFSE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:RUBEN
Authorized Official - Last Name:ARANGO
Authorized Official - Suffix:
Authorized Official - Credentials:10269
Authorized Official - Phone:787-793-5959
Mailing Address - Street 1:PO BOX 42006
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00940-2206
Mailing Address - Country:US
Mailing Address - Phone:787-793-5959
Mailing Address - Fax:787-767-4779
Practice Address - Street 1:CARR. 838 KM 6.3 URB CARIBE SECTOR EL CINCO
Practice Address - Street 2:CALLE PONCE DE LEON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-793-5353
Practice Address - Fax:787-767-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10269261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local