Healthcare Provider Details

I. General information

NPI: 1720229057
Provider Name (Legal Business Name): INTEGRATE COMMUNITY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CALLE SANTA CRUZ
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 455 400 CALLE CALAF
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-2387
  • Fax: 787-780-6530
Mailing address:
  • Phone: 787-234-8865
  • Fax: 787-274-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN SOLIVAN
Title or Position: PRESIDENT
Credential:
Phone: 787-650-7294