MEDICARE: INTEGRITY BEHAVIORAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	18796	PR
2	2084P0804X	Child & Adolescent Psychiatry Physician	18796	PR

General Provider Information

NPI Number	:	1477947240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY BEHAVIORAL GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 366217
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-6217
Country	:	US
Telephone Number	:	787-282-3702
Fax Number	:	787-282-3702

Provider Business Practice Location Address
First Line	:	122 CALLE ELEONOR ROOSEVELT
Second Line	:	SECOND FLOOR
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3133
Country	:	US
Telephone Number	:	787-282-3702
Fax Number	:	787-282-3702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALEXIS TORRES RODRIGUEZ
Credential	:	M.D.
Telephone Number	:	787-282-3702

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/20/2015

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