Healthcare Provider Details

I. General information

NPI: 1437234309
Provider Name (Legal Business Name): INTEGRA TOTAL MANAGED CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 AVE. PONCE DE LEON SUTIE 600
SAN JUAN PR
00907
US

IV. Provider business mailing address

1254 AVE. PONCE DE LEON SUTIE 600
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-649-7045
  • Fax: 787-743-4260
Mailing address:
  • Phone: 787-649-7045
  • Fax: 787-743-4260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number163720
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE MIGUEL FRANQUIZ MATOS
Title or Position: DIRECTOR MEDICO
Credential: M.D.
Phone: 787-649-7045