Provider Demographics
NPI:1316158132
Name:INICIATIVA COMUNITARIA, INC
Entity type:Organization
Organization Name:INICIATIVA COMUNITARIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGAS VIDOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-250-8629
Mailing Address - Street 1:61 CALLE QUISQUEYA
Mailing Address - Street 2:PO BOX 366535
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-1202
Mailing Address - Country:US
Mailing Address - Phone:787-250-8629
Mailing Address - Fax:787-753-4454
Practice Address - Street 1:STREET QUISQUEYA # 61
Practice Address - Street 2:ESQ CHILE
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00936-6535
Practice Address - Country:US
Practice Address - Phone:787-250-8629
Practice Address - Fax:787-753-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health