MEDICARE: CENTRAL MEDICAL LAB CORP

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	291U00000X	Clinical Medical Laboratory	1049	PR

General Provider Information

NPI Number	:	1124157821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MEDICAL LAB CORP

Provider Business Mailing Address
First Line	:	5-5 CALLE 8
Second Line	:	SABANA GARDENS
City	:	CAROLINA
State	:	PR
Zip	:	00983-2966
Country	:	US
Telephone Number	:	787-762-0445
Fax Number	:	787-750-7555

Provider Business Practice Location Address
First Line	:	5-5 CALLE 8
Second Line	:	SABANA GARDENS
City	:	CAROLINA
State	:	PR
Zip	:	00983-2966
Country	:	US
Telephone Number	:	787-762-0445
Fax Number	:	787-750-7555

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	DR. ARMANDO VICENTE
Credential	:	MD
Telephone Number	:	787-762-0445

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	12/12/2007

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