Healthcare Provider Details

I. General information

NPI: 1770405169
Provider Name (Legal Business Name): SALUD INTEGRAL EN LA MONTANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CALLE SANTA CRUZ
BAYAMON PR
00961-6900
US

IV. Provider business mailing address

PO BOX 515
NARANJITO PR
00719-0515
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GLORIA AMADOR FERNANDEZ
Title or Position: CEO
Credential:
Phone: 787-869-5900