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General NPI Number Information
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NPI Number | 1639239460
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Entity Type | Organization
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Legal Business Name | CLINICAL MANAGEMENT GROUP INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | URB. PARADIS B-24 C LOPE FLORES
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-743-2114
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Fax | 787-743-2114
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Provider Business Mailing Address
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Address Line | PO BOX 4956 PMB 2190
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City | CAGUAS
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State | PR
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Zip | 00726-4956
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Country | US
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Telephone | 787-746-2114
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Fax | 787-743-2114
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Authorized Official
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Title or Position | GENERAL SUPERVISOR
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Name | MR. EDGARDO L LOPEZ
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Credential | LCDO.
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Telephone | 787-743-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 415
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License Number State | PR
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