# INTERNATIONAL CLINITIAN MEDICAL GROUP PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457670291
- **Authorized official:** PEDRO CARRAZANA (PRESIDENT)
- **Authorized official phone:** (787) 587-5410

## Contact information

- **Practice address:** AVE HOSTO \#54, SAN JUAN, PR 00919
- **Practice address phone:** (787) 587-5410
- **Mailing address:** PO BOX 1198, BAYAMON, PR 00960-1198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 15309 | PR | Yes |

## Other

- **Enumeration date:** 05/19/2010
- **Last updated:** 05/19/2010