Provider Demographics
NPI:1437234309
Name:INTEGRA TOTAL MANAGED CARE INC
Entity Type:Organization
Organization Name:INTEGRA TOTAL MANAGED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE MIGUEL
Authorized Official - Middle Name:FRANQUIZ
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-649-7045
Mailing Address - Street 1:1254 AVE. PONCE DE LEON
Mailing Address - Street 2:SUTIE 600
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-649-7045
Mailing Address - Fax:787-743-4260
Practice Address - Street 1:1254 AVE. PONCE DE LEON
Practice Address - Street 2:SUTIE 600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-649-7045
Practice Address - Fax:787-743-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR163720302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization