Provider Demographics
NPI:1306157573
Name:INTEGRITY MEDICAL GROUP, CORP
Entity type:Organization
Organization Name:INTEGRITY MEDICAL GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JESLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-452-5504
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-9438
Mailing Address - Country:US
Mailing Address - Phone:787-452-5504
Mailing Address - Fax:787-872-8162
Practice Address - Street 1:CARR 474 ESTANCIAS PARAISO #110
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-452-5504
Practice Address - Fax:787-872-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty