NPIMap

Organization Active NPI

Centro Isabelino de Medicina Avanzada Em

  • Clinical Medical Laboratory
  • Isabela, PR
National Provider Identifier
1336289362
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
40D0933267 Issued in PR
Legal business name
CENTRO ISABELINO DE MEDICINA AVANZADA EM
Practice address
Ave Agustin Ramos Calero
KM 1.1 Int
Isabela, PR 00662
Phone
(787) 830-2705
Fax
(787) 830-0465
NPI assigned
Feb 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sondra O Gerena Cortes
Title
Director de Operaciones
Phone
(787) 830-2705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 40D0933267 PR Primary

Addresses

Primary practice location

Ave Agustin Ramos Calero
KM 1.1 Int
Isabela, PR 00662

Mailing address

PO Box 737
Isabela, PR 00662
Phone (787) 830-2705

Other names 1

  • Centro Isabelino de Medicina Avanzada EM Laboratorio Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240327001186 PR Part B Supplier - Independent Clinical Laboratory 4880031723 Practice locations: Isabela, PR

National Provider Directory

National Provider Directory
Tax ID family
Centro Isabelino de Med Avanzada Cima5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1336289362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 737",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "00662",
            "telephone_number": "787-830-2705",
            "fax_number": "787-830-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "AVE AGUSTIN RAMOS CALERO",
            "address_2": "KM 1.1 INT",
            "city": "ISABELA",
            "state": "PR",
            "postal_code": "00662",
            "telephone_number": "787-830-2705",
            "fax_number": "787-830-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO ISABELINO DE MEDICINA AVANZADA EM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "GERENA CORTES",
        "authorized_official_first_name": "SONDRA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DIRECTOR DE OPERACIONES",
        "authorized_official_telephone_number": "787-830-2705"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "40D0933267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centro Isabelino de Medicina Avanzada EM Laboratorio",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Isabela, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.