Provider Demographics
NPI:1609328616
Name:INICIATIVA COMUNITARIA DE INVESTIGACION
Entity Type:Organization
Organization Name:INICIATIVA COMUNITARIA DE INVESTIGACION
Other - Org Name:CENTRO PARA LA VIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL OFICIAL EJECUTIVO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGAS
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:787-767-0389
Practice Address - Street 1:61 CALLE QUISQUELLA
Practice Address - Street 2:ESQUINA CHILE
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-250-8629
Practice Address - Fax:787-767-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0000000095261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center