MEDICARE: CARIBE PATHOLOGY CSP

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	174400000X	Specialist		PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	20170	OTHER	PR	PREFERRED MEDICARE CHOICE
4	601098	OTHER	PR	MEDICARE Y MUCHO MAS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100041	OTHER	PR	CRUZ AZUL
3	5106085	OTHER	PR	UIA
5	PE4613	OTHER	PR	PAN AMERICAN
6	221055	OTHER	PR	PREFERRED UTI
7	6800165	OTHER	PR	HUMANA INSURANCE
8	5618	OTHER	PR	FIRST MEDICAL

General Provider Information

NPI Number	:	1164417168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARIBE PATHOLOGY CSP

Provider Business Mailing Address
First Line	:	PO BOX 3605
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-3605
Country	:	US
Telephone Number	:	787-834-1021
Fax Number	:	787-834-1051

Provider Business Practice Location Address
First Line	:	CARR 349 KM. 2.7 CERRO LAS MESAS
Second Line	:	HOSPITAL BELLA VISTA
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-0000
Country	:	US
Telephone Number	:	787-834-1021
Fax Number	:	787-834-1051

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MRS. IVETTE MEJIAS
Credential	:
Telephone Number	:	787-834-1021

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	08/22/2020

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Directions to “CARIBE PATHOLOGY CSP ” Practice Location

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