MEDICARE: CLINIC MANAGEMENT CORPORATION OF AMERICA

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

General Provider Information

NPI Number	:	1962649418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIC MANAGEMENT CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	PO BOX 29166
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00929-0166
Country	:	US
Telephone Number	:	787-641-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	282 AVE JESUS T PINERO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-3921
Country	:	US
Telephone Number	:	787-763-2125
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	DR. SULTAN SALEH YASSIN
Credential	:	PHARMD
Telephone Number	:	787-598-9459

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/20/2009

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