Provider Demographics
NPI:1114545977
Name:PUENTES DE SALVD
Entity Type:Organization
Organization Name:PUENTES DE SALVD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DACEY
Authorized Official - Middle Name:BOINAIV
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:207-664-8738
Mailing Address - Street 1:1700 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146
Mailing Address - Country:US
Mailing Address - Phone:215-454-8000
Mailing Address - Fax:215-893-2251
Practice Address - Street 1:1700 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146
Practice Address - Country:US
Practice Address - Phone:215-454-8000
Practice Address - Fax:215-893-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine