Provider Demographics
NPI:1689724817
Name:INSTITUTO SALUD INTEGRAL DE MAYAGUEZ
Entity Type:Organization
Organization Name:INSTITUTO SALUD INTEGRAL DE MAYAGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-831-0396
Mailing Address - Street 1:445 AVE GONZALEZ CLEMENTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1136
Mailing Address - Country:US
Mailing Address - Phone:787-831-0396
Mailing Address - Fax:787-831-0396
Practice Address - Street 1:445 AVE GONZALEZ CLEMENTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1136
Practice Address - Country:US
Practice Address - Phone:787-831-0396
Practice Address - Fax:787-831-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty