Provider Demographics
NPI:1760948947
Name:CMT GROUP, CORP
Entity Type:Organization
Organization Name:CMT GROUP, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-754-6868
Mailing Address - Street 1:UNIVERSITY GARDENS
Mailing Address - Street 2:300 CALLE CLEMSON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-754-6868
Mailing Address - Fax:787-274-9280
Practice Address - Street 1:UNIVERSITY GARDENS
Practice Address - Street 2:300 CALLE CLEMSON
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?:Yes
Parent Organization LBN:CMT GROUP CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCNC14029Medicaid