Healthcare Provider Details

I. General information

NPI: 1740772102
Provider Name (Legal Business Name): SALUD INTEGRAL EN LA MONTANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 167 KM 17.8 BO. PAJAROS PUERTORRIQUENOS
BAYAMON PR
00961
US

IV. Provider business mailing address

PO BOX 515
NARANJITO PR
00719-0515
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-3435
  • Fax: 787-780-3435
Mailing address:
  • Phone: 787-869-5900
  • Fax: 787-869-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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