1346789203 NPI number — SALUD INTEGRAL EN LA MONTANA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346789203 NPI number — SALUD INTEGRAL EN LA MONTANA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALUD INTEGRAL EN LA MONTANA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346789203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 515
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00719-0515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-869-5900
Provider Business Mailing Address Fax Number:
787-869-6120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR PR 155 SECTOR EL DESVIO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROCOVIS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-867-6010
Provider Business Practice Location Address Fax Number:
787-867-5210
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
AMADOR FERNANDEZ
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
DEL C.
Authorized Official Title or Position:
DIRECTORA EJECUTIVA
Authorized Official Telephone Number:
787-869-5900

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1354 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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