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General NPI Number Information
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NPI Number | 1902282247
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Entity Type | Organization
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Legal Business Name | INICIATIVA COMUNITARIA DE INVESTIGACION
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | CALLE TOSCANIA #1196 URB. VILLA CAPRI
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-283-1520
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 366535 URBANIZACION VILLA CAPRI CALLE TOSCANIA 1196
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City | SAN JUAN
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State | PR
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Zip | 00926-6535
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Country | US
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Telephone | 787-283-1520
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | DR. DIANA CAMACHO VARGAS
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Credential | PSY.D.
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Telephone | 787-283-1520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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