# INTEGRA TOTAL MANAGE CARE PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720364904
- **Authorized official:** DR. VICTOR HERNANDEZ M.D. LIC. 11034 (PRESIDENT)
- **Authorized official phone:** (787) 307-3399

## Contact information

- **Practice address:** PONCE DE LEON AVENUE 402 UNION PLAZA BLD., SUITE 802, SAN JUAN, PR 00917
- **Practice address phone:** (787) 758-3206
- **Practice address fax:** (787) 772-4724
- **Mailing address:** PO BOX 367312, SAN JUAN, PR 00936-7312
- **Mailing address phone:** (787) 758-3206
- **Mailing address fax:** (787) 772-4724

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |
| 305R00000X | Preferred Provider Organization | — | NULL | — |

## Other

- **Enumeration date:** 11/01/2011
- **Last updated:** 02/02/2012