Healthcare Provider Details

I. General information

NPI: 1194966424
Provider Name (Legal Business Name): INTEGRATE COMMUNITY HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CALAF STREET PMB 455
SAN JUAN PR
00918-1314
US

IV. Provider business mailing address

CARR. #3 KM 13.4 BO. CANOVANILLAS FIRST MEDICAL BUILDING
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-4234
  • Fax: 787-274-8895
Mailing address:
  • Phone: 787-993-4990
  • Fax: 787-993-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER RIVERA
Title or Position: FINANCE SUPERVISOR
Credential:
Phone: 787-641-4234