Healthcare Provider Details

I. General information

NPI: 1609328616
Provider Name (Legal Business Name): INICIATIVA COMUNITARIA DE INVESTIGACION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CALLE QUISQUELLA ESQUINA CHILE
HATO REY PR
00918
US

IV. Provider business mailing address

PO BOX 366535
SAN JUAN PR
00936-6535
US

V. Phone/Fax

Practice location:
  • Phone: 787-250-8629
  • Fax: 787-767-0389
Mailing address:
  • Phone: 787-250-8629
  • Fax: 787-767-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0000000095
License Number StatePR

VIII. Authorized Official

Name: NAISKA SANTIAGO GUZMAN
Title or Position: CLINC COORDINATOR
Credential:
Phone: 787-250-8629