1659914208 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 1659914208 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:
1659914208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2019
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 167 KM 17.8
Provider Second Line Business Practice Location Address:
BO. PAJAROS PUERTORRIQUENOS
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-780-3435
Provider Business Practice Location Address Fax Number:
787-780-3435
Provider Enumeration Date:
10/25/2019

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:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-869-5900

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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