# LIC EXPRESS-INTERNISTA INC

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

## Provider details

- **NPI number:** 1558016634
- **Authorized official:** NICOLAS BEZARES TORRES MD (PRESIDENTE)
- **Authorized official phone:** (787) 347-7863

## Contact information

- **Practice address:** 6 CALLE PROLONGACION C AGUILER, CAGUAS, PR 00725-2830
- **Practice address phone:** (787) 744-5042
- **Practice address fax:** (787) 286-1313
- **Mailing address:** 6 CALLE PROLONGACION C AGUILER, CAGUAS, PR 00725-2830
- **Mailing address phone:** (787) 744-5042
- **Mailing address fax:** (787) 286-1313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/16/2022
- **Last updated:** 02/18/2022