Provider Demographics
NPI:1235346461
Name:CENTROS MEDICOS INTEGRADOS DE LA MONTANA
Entity Type:Organization
Organization Name:CENTROS MEDICOS INTEGRADOS DE LA MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-747-0022
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-2010
Mailing Address - Country:US
Mailing Address - Phone:787-747-0022
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-747-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherSEGURO SOCIAL PATRONAL