Provider Demographics
NPI:1053508267
Name:TALLER INTEGRAL CORP.
Entity Type:Organization
Organization Name:TALLER INTEGRAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA DE LOS
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:DE JESUS GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-884-0087
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0046
Mailing Address - Country:US
Mailing Address - Phone:787-884-0087
Mailing Address - Fax:
Practice Address - Street 1:CALLE 10 BLOQUE 3 #32
Practice Address - Street 2:URBANIZACION VILLA NITZA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0046
Practice Address - Country:US
Practice Address - Phone:787-884-0087
Practice Address - Fax:787-884-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1136261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1659443026OtherINDIVIDUL NPI
PR=========OtherEIN