Healthcare Provider Details

I. General information

NPI: 1407195373
Provider Name (Legal Business Name): FUNDACION DE INVESTIGACION DE DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 AVE MUNOZ RIVERA
SAN JUAN PR
00927-4308
US

IV. Provider business mailing address

998 AVE MUNOZ RIVERA
SAN JUAN PR
00927-4308
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-1248
  • Fax: 787-721-6098
Mailing address:
  • Phone: 787-722-1248
  • Fax: 787-721-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE F RODRIGUEZ-ORENGO
Title or Position: COO
Credential: PHD
Phone: 787-722-1248