Provider Demographics
NPI:1275556946
Name:SALUD INTEGRAL EN LA MONTANA, INC
Entity Type:Organization
Organization Name:SALUD INTEGRAL EN LA MONTANA, INC
Other - Org Name:CENTRO DE SALUD INTEGRAL EN COMERIO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DEL C
Authorized Official - Last Name:AMADOR FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-5900
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0515
Mailing Address - Country:US
Mailing Address - Phone:787-869-5900
Mailing Address - Fax:787-722-2980
Practice Address - Street 1:CALLE GEORGETTI, CARR 167 ENTRADA PUEBLO
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-875-3375
Practice Address - Fax:787-875-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR38261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10080Medicare ID - Type Unspecified