Provider Demographics
NPI:1619245487
Name:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Entity Type:Organization
Organization Name:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Other - Org Name:CDT REGION ARECIBO
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-793-5959
Mailing Address - Street 1:PO BOX 365028
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5028
Mailing Address - Country:US
Mailing Address - Phone:787-793-5959
Mailing Address - Fax:787-782-0870
Practice Address - Street 1:CARR 2 AVE MIRAMAR
Practice Address - Street 2:KM 78.7
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-793-5959
Practice Address - Fax:787-782-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR125261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local