Healthcare Provider Details

I. General information

NPI: 1225274178
Provider Name (Legal Business Name): SERVICIOS MEDICOS INTEGRADOS DE FAJARDO, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE PRINCIPAL I-23 URB. BARALT
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 827
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-7646
  • Fax: 787-860-7357
Mailing address:
  • Phone: 787-863-7646
  • Fax: 787-860-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AGAPITO FONTANEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-863-7646