1679025720 NPI number — SALUD INTEGRAL EN LA MONTANA, INC

Table of content: (NPI 1679025720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679025720 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:
6
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:
1679025720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2018
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 891 KM 15.1
Provider Second Line Business Practice Location Address:
BO PUEBLO
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-859-2560
Provider Business Practice Location Address Fax Number:
787-859-5390
Provider Enumeration Date:
10/25/2016

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: 261QM0801X , 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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