Healthcare Provider Details

I. General information

NPI: 1942687850
Provider Name (Legal Business Name): EMPRESA MUNICIPAL SALUD INTEGRAL DE LA TIERRA ALTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE ROSANTA AULET
JAYUYA PR
00664-1328
US

IV. Provider business mailing address

PO BOX 410
JAYUYA PR
00664-0410
US

V. Phone/Fax

Practice location:
  • Phone: 787-828-0305
  • Fax: 787-828-0901
Mailing address:
  • Phone: 787-828-0305
  • Fax: 787-828-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number116
License Number StatePR

VIII. Authorized Official

Name: MRS. WANDA I ZAMORA
Title or Position: GERENTE ADMINISTRATIVO
Credential:
Phone: 787-828-0305