Provider Demographics
NPI:1215431580
Name:CMT GROUP, CORP
Entity type:Organization
Organization Name:CMT GROUP, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-754-6868
Mailing Address - Street 1:PO BOX 51502
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1502
Mailing Address - Country:US
Mailing Address - Phone:787-754-6868
Mailing Address - Fax:787-274-9280
Practice Address - Street 1:URB UNIVERSITY GARDENS
Practice Address - Street 2:300 CALLE CLEMSON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
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
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR67261QU0200X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR492OtherDEPT OF HEALTH