Provider Demographics
NPI:1326852880
Name:INTEGRAVIDA, LLC
Entity type:Organization
Organization Name:INTEGRAVIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:ISIS
Authorized Official - Middle Name:SERRANO
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-354-7466
Mailing Address - Street 1:URBANIZACION FUENTEBELLA
Mailing Address - Street 2:1670 CALLE TORINO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-354-7466
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5035
Practice Address - Country:US
Practice Address - Phone:787-354-7466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty