Healthcare Provider Details

I. General information

NPI: 1114545977
Provider Name (Legal Business Name): PUENTES DE SALVD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SOUTH STREET
PHILADELPHIA PA
19146
US

IV. Provider business mailing address

1700 SOUTH STREET
PHILADELPHIA PA
19146
US

V. Phone/Fax

Practice location:
  • Phone: 215-454-8000
  • Fax: 215-893-2251
Mailing address:
  • Phone: 215-454-8000
  • Fax: 215-893-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DACEY BOINAIV STRATTON
Title or Position: MEDICAL DIRECTOR
Credential: CRNP
Phone: 207-664-8738