Healthcare Provider Details

I. General information

NPI: 1003734609
Provider Name (Legal Business Name): SALUD INTEGRAL EN LA MONTANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

950 CARR 891
COROZAL PR
00783-2323
US

IV. Provider business mailing address

PO BOX 515
COROZAL PR
00783-0515
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-2560
  • Fax: 787-859-5390
Mailing address:
  • Phone: 787-869-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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