Healthcare Provider Details

I. General information

NPI: 1669607370
Provider Name (Legal Business Name): LA FONDITA DE JESUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 CALLE MONSERRATE
SAN JUAN PR
00907-4511
US

IV. Provider business mailing address

PO BOX 19384
SAN JUAN PR
00910-1384
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-4051
  • Fax: 787-722-0992
Mailing address:
  • Phone: 787-724-4051
  • Fax: 787-722-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRISH FIGUEROA
Title or Position: COORDINADORA
Credential:
Phone: 787-724-4051