Healthcare Provider Details

I. General information

NPI: 1144323692
Provider Name (Legal Business Name): SALUD INTEGRAL EN LA MONTANA,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 152 KM 12 HM 4 BOX 515
NARANJITO PR
00719-0515
US

IV. Provider business mailing address

CARR 813 KM 1.5 HC 71 BOX 1897
NARANJITO PR
00719-9510
US

V. Phone/Fax

Practice location:
  • Phone: 787-869-5900
  • Fax: 787-722-6980
Mailing address:
  • Phone: 787-869-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1544
License Number StatePR

VIII. Authorized Official

Name: MR. JAVIER MATOS
Title or Position: PHARMACY TECHNICIAN
Credential:
Phone: 787-869-5900