Provider Demographics
NPI:1700303468
Name:CARIBE PHYSICIANS PLAZA CORPORATION
Entity Type:Organization
Organization Name:CARIBE PHYSICIANS PLAZA CORPORATION
Other - Org Name:CARIBBEAN MEDICAL CENTER RADIOLOGIA AMBULATORIA
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-801-0081
Mailing Address - Street 1:PO BOX 70006
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7006
Mailing Address - Country:US
Mailing Address - Phone:787-801-0081
Mailing Address - Fax:787-801-0087
Practice Address - Street 1:151 AVE OSVALDO MOLINA
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4013
Practice Address - Country:US
Practice Address - Phone:787-801-0081
Practice Address - Fax:787-522-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIN276AMedicaid