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General NPI Number Information
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NPI Number | 1649719824
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Entity Type | Organization
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Legal Business Name | CORPORACION FONDO DEL SEGURO DEL ESTADO BAYAMON
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | CARRETERA ESTATAL 2 KM 8.5
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City | BAYAMON
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State | PR
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Zip | 00960
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Country | US
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Telephone | 787-782-8250
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Fax | 787-782-8208
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Provider Business Mailing Address
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Address Line | CARR ESTATAL 2 KM 8.5 BO JUAN SANCHEZ
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City | BAYAMON
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State | PR
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Zip | 00960-0248
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Country | US
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Telephone | 787-782-8250
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Fax | 787-782-8208
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARIA I LASTRA
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Credential | MD
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Telephone | 787-782-8250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number | 120
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License Number State | PR
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