Provider Demographics
NPI:1538545710
Name:SALUD INTEGRAL EN LA MONTANA, INC.
Entity type:Organization
Organization Name:SALUD INTEGRAL EN LA MONTANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:YAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD,LND
Authorized Official - Phone:787-397-7765
Mailing Address - Street 1:4 CARR 165
Mailing Address - Street 2:BO. QUEDRADA CRUZ
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2338
Mailing Address - Country:US
Mailing Address - Phone:787-545-8808
Mailing Address - Fax:
Practice Address - Street 1:4 CARR 165
Practice Address - Street 2:BO. QUEDRADA CRUZ
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2338
Practice Address - Country:US
Practice Address - Phone:787-545-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1904261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)