Provider Demographics
NPI:1992092555
Name:INICIATIVA COMUNITARIA DE INVESTIGACION
Entity type:Organization
Organization Name:INICIATIVA COMUNITARIA DE INVESTIGACION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXCECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VARGAS-VIDOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-250-8629
Mailing Address - Street 1:PO BOX 366535
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6535
Mailing Address - Country:US
Mailing Address - Phone:787-250-8629
Mailing Address - Fax:787-753-4454
Practice Address - Street 1:100 AVE LAUREL
Practice Address - Street 2:HOSPITAL RAMON RUIZ ARNAU
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4816
Practice Address - Country:US
Practice Address - Phone:787-338-8383
Practice Address - Fax:787-338-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0401X261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health