MEDICARE: INTEGRATED HEALTHCARE CENTER,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	000531	PR

General Provider Information

NPI Number	:	1538585666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HEALTHCARE CENTER,INC

Provider Business Mailing Address
First Line	:	PO BOX 9023879
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00902-3879
Country	:	US
Telephone Number	:	787-722-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 CALLE VICTORIA
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00912-3123
Country	:	US
Telephone Number	:	787-724-6063
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	MS. EDNA VAZQUEZ GORDIS
Credential	:
Telephone Number	:	787-406-8932

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	06/19/2014

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