Provider Demographics
NPI:1972671204
Name:STATE INSURANCE FUND
Entity Type:Organization
Organization Name:STATE INSURANCE FUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL INSPECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSACARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-882-2700
Mailing Address - Street 1:HC 6 BOX 62992
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROAD #2 KM127.3 BLDNG STATE INSURANCE FUND
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5190261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health