Healthcare Provider Details

I. General information

NPI: 1053508267
Provider Name (Legal Business Name): TALLER INTEGRAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 10 BLOQUE 3 #32 URBANIZACION VILLA NITZA
MANATI PR
00674-0046
US

IV. Provider business mailing address

PO BOX 46
MANATI PR
00674-0046
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-0087
  • Fax: 787-884-0087
Mailing address:
  • Phone: 787-884-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1136
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1136
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1659443026
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerINDIVIDUL NPI

VIII. Authorized Official

Name: DR. MARIA DE LOS ANGELES DE JESUS GARCIA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 787-884-0087