Provider Demographics
NPI:1861363004
Name:FUNDACION MI GRAN SUENO, INCORPORADO
Entity type:Organization
Organization Name:FUNDACION MI GRAN SUENO, INCORPORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FUNDADOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINTANA MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-431-6101
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1595
Mailing Address - Country:US
Mailing Address - Phone:787-431-6101
Mailing Address - Fax:
Practice Address - Street 1:CARR. 442 KM 1.5 INTERIOR BO. ESPINAL
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-252-6464
Practice Address - Fax:787-252-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty