Healthcare Provider Details

I. General information

NPI: 1972704195
Provider Name (Legal Business Name): CFSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CFSE CARR #3, AVE. 65 INFANTERIA INTERSECCION CARR 887 BO. SAN ANTON
CAROLINA PR
00986-0858
US

IV. Provider business mailing address

PO BOX 14522 BO OBRERO STATION
SAN JUAN PR
00916-4522
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-6850
  • Fax: 787-776-2252
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13147
License Number StatePR

VIII. Authorized Official

Name: DR. MARITA J FLAZ
Title or Position: M.D.
Credential: M.D.
Phone: 787-246-4176