Provider Demographics
NPI:1114033560
Name:CARIBBEAN MEDICAL TESTING CENTER
Entity Type:Organization
Organization Name:CARIBBEAN MEDICAL TESTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-754-6868
Mailing Address - Street 1:PO BOX 192071
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2071
Mailing Address - Country:US
Mailing Address - Phone:787-754-6868
Mailing Address - Fax:787-274-9280
Practice Address - Street 1:300 CLEMSON ST
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-754-6868
Practice Address - Fax:787-274-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR67261QH0100X
PR492291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00OtherMCS COMERCIAL
PR00OtherSSS
30459OtherSSS MEDICARE OPTIMO
PR20326OtherPMC
800461OtherMMM
PR00OtherFIRST PLUS
R58627260OtherBLUE SHIELD
20308LOtherAMERICAN HEALTH INC
PR30459OtherMEDICARE
9270096OtherHUMANA HEALTH
1313OtherAPS
PR00OtherSSS
20308LOtherAMERICAN HEALTH INC
PR20326OtherPMC
=========OtherPALIC
=========OtherIMC