=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255489969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO MEDICAL CARIBBEAN CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 728 AVE DE DIEGO STE 2 CAPARRA TERRACE, PUERTO NUEVO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00920-5006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-782-1422
-----------------------------------------------------
Fax | 787-728-1424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9024272
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00902-4272
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-782-1422
-----------------------------------------------------
Fax | 787-728-1424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR (CEO)
-----------------------------------------------------
Name | MRS. AIDA LUZ MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-782-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------