=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609882869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALUD INTEGRAL EN LA MONTANA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. PR-164, BARRIO ACHIOTE SECTOR EL DESVIO
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-869-5900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 515
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719-0515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-869-5900
-----------------------------------------------------
Fax | 787-722-6980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SANDRA V GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-869-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------