Healthcare Provider Details

I. General information

NPI: 1366517559
Provider Name (Legal Business Name): FCIA SAN FELIPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 KM 15 0 BAYANEY
HATILLO PR
00659
US

IV. Provider business mailing address

BOX 78
ANGELES PR
00611
US

V. Phone/Fax

Practice location:
  • Phone: 787-898-6378
  • Fax: 787-898-6378
Mailing address:
  • Phone: 787-898-6378
  • Fax: 787-898-6378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07F0623
License Number StatePR

VIII. Authorized Official

Name: MR. HECTOR RAUL CINTRON
Title or Position: PRESIDENTE
Credential:
Phone: 787-898-6378