MEDICARE: INICIATIVA COMUNITARIA DE INVESTIGACION, 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	208D00000X	General Practice Physician	0000000095	PR

General Provider Information

NPI Number	:	1609328616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INICIATIVA COMUNITARIA DE INVESTIGACION, INC

Provider Business Mailing Address
First Line	:	PO BOX 366535
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-6535
Country	:	US
Telephone Number	:	787-250-8629
Fax Number	:	787-767-0389

Provider Business Practice Location Address
First Line	:	61 CALLE QUISQUELLA
Second Line	:	ESQUINA CHILE
City	:	HATO REY
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:	787-250-8629
Fax Number	:	787-767-0389

Authorized Official
Title or Position	:	CLINC COORDINATOR
Name	:	NAISKA SANTIAGO GUZMAN
Credential	:
Telephone Number	:	787-250-8629

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	05/08/2026

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