Provider Demographics
NPI:1336354729
Name:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Entity Type:Organization
Organization Name:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-8700
Mailing Address - Street 1:1 CALLE CAPARRA
Mailing Address - Street 2:URB. PONCE DE LEON
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5123
Mailing Address - Country:US
Mailing Address - Phone:787-833-8700
Mailing Address - Fax:787-834-2715
Practice Address - Street 1:AVE. CORAZONES 1040
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-833-8700
Practice Address - Fax:787-834-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5896261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine