MEDICARE: CARIBBEAN MEDICAL MANAGEMENT

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

General Provider Information

NPI Number	:	1902161433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARIBBEAN MEDICAL MANAGEMENT

Provider Business Mailing Address
First Line	:	189 ST. AVE JOSE VILLARES O-13
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-3145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	O13 AVE JOSE VILLARES
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-3145
Country	:	US
Telephone Number	:	787-539-8965
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	MARIO LOZADA
Credential	:
Telephone Number	:	787-539-8965

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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