Provider Demographics
NPI:1164417168
Name:CARIBE PATHOLOGY CSP
Entity Type:Organization
Organization Name:CARIBE PATHOLOGY CSP
Other - Org Name:CARIBEPATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-1021
Mailing Address - Street 1:PO BOX 3605
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3605
Mailing Address - Country:US
Mailing Address - Phone:787-834-1021
Mailing Address - Fax:787-834-1051
Practice Address - Street 1:CARR 349 KM. 2.7 CERRO LAS MESAS
Practice Address - Street 2:HOSPITAL BELLA VISTA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-834-1021
Practice Address - Fax:787-834-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100041OtherCRUZ AZUL
PR20170OtherPREFERRED MEDICARE CHOICE
PR5106085OtherUIA
PR601098OtherMEDICARE Y MUCHO MAS
PRPE4613OtherPAN AMERICAN
PR221055OtherPREFERRED UTI
PR6800165OtherHUMANA INSURANCE
PR5618OtherFIRST MEDICAL
PR100041OtherCRUZ AZUL
PR6800165OtherHUMANA INSURANCE
PR221055OtherPREFERRED UTI
PR5106085OtherUIA