Provider Demographics
NPI:1003259292
Name:CARRIBEAN MEDICAL GROUP
Entity Type:Organization
Organization Name:CARRIBEAN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-3851
Mailing Address - Street 1:J23 CALLE ELLIOT VELEZ
Mailing Address - Street 2:URB ATENAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4616
Mailing Address - Country:US
Mailing Address - Phone:787-854-3851
Mailing Address - Fax:787-854-3824
Practice Address - Street 1:J23 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-854-3851
Practice Address - Fax:787-854-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization