Healthcare Provider Details

I. General information

NPI: 1811753155
Provider Name (Legal Business Name): INTEGRALIS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 RUTA 474
ISABELA PR
00662-4023
US

IV. Provider business mailing address

PO BOX 2537
ISABELA PR
00662-9537
US

V. Phone/Fax

Practice location:
  • Phone: 939-323-0563
  • Fax:
Mailing address:
  • Phone: 939-323-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: OMAR ANTONIO SAMOT
Title or Position: PRESIDENT
Credential: LIC.
Phone: 939-717-1653