Healthcare Provider Details

I. General information

NPI: 1174009013
Provider Name (Legal Business Name): SALUD INTEGRAL EN LA MONTANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 156 CALLE BARCELO 53
BARRANQUITAS PR
00794
US

IV. Provider business mailing address

PO BOX 515
NARANJITO PR
00719-0515
US

V. Phone/Fax

Practice location:
  • Phone: 787-857-2688
  • Fax: 787-857-1730
Mailing address:
  • Phone: 787-869-5900
  • Fax: 787-869-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLORIA DEL C. AMADOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-869-5900