Healthcare Provider Details

I. General information

NPI: 1114033560
Provider Name (Legal Business Name): CARIBBEAN MEDICAL TESTING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CLEMSON ST UNIVERSITY GARDENS
SAN JUAN PR
00927
US

IV. Provider business mailing address

PO BOX 192071
SAN JUAN PR
00919-2071
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-6868
  • Fax: 787-274-9280
Mailing address:
  • Phone: 787-754-6868
  • Fax: 787-274-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number67
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number492
License Number StatePR

VIII. Authorized Official

Name: MR. ANGEL VALE
Title or Position: PRESIDENT
Credential:
Phone: 787-754-6868