Provider Demographics
NPI:1689106932
Name:CORPORACION FONDO SEGURO ESTADO AGUADILLA
Entity Type:Organization
Organization Name:CORPORACION FONDO SEGURO ESTADO AGUADILLA
Other - Org Name:CFSE AGUADILLA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-891-0805
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0336
Mailing Address - Country:US
Mailing Address - Phone:787-891-0805
Mailing Address - Fax:787-882-4605
Practice Address - Street 1:CARR 2 KM 126.4
Practice Address - Street 2:BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-0805
Practice Address - Fax:787-882-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8543261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local