1316158132 NPI number — INICIATIVA COMUNITARIA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316158132 NPI number — INICIATIVA COMUNITARIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INICIATIVA COMUNITARIA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316158132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 CALLE QUISQUEYA
Provider Second Line Business Mailing Address:
PO BOX 366535
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-250-8629
Provider Business Mailing Address Fax Number:
787-753-4454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STREET QUISQUEYA # 61
Provider Second Line Business Practice Location Address:
ESQ CHILE
Provider Business Practice Location Address City Name:
HATO REY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00936-6535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-250-8629
Provider Business Practice Location Address Fax Number:
787-753-4454
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VARGAS VIDOT
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICO
Authorized Official Telephone Number:
787-250-8629

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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