| NPI | 1114322914 |
|---|---|
| Other Name | N/A |
| Entity Type | Organization |
| Authorized Contact | GLADYS YADIRA MONTALVO Vice President 787-310-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: PR 5498) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2015-03-14 |