=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326141888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUD INTEGRAL EN LA MONTAA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR 152 KM 12 HM 4 APARTADO 515
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719-0515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-869-5900
-----------------------------------------------------
Fax | 787-722-6980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE GEORGETTI 126 BOX 207
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-869-5137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MRS. LOURDES B CHEVRES
-----------------------------------------------------
Credential | PH
-----------------------------------------------------
Telephone | 787-869-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 3139
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------