Provider Demographics
NPI:1770771214
Name:CRM GRUPO PROFESIONAL MEDICOS, CSP
Entity type:Organization
Organization Name:CRM GRUPO PROFESIONAL MEDICOS, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOYKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-3350
Mailing Address - Street 1:PO BOX 51083
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1083
Mailing Address - Country:US
Mailing Address - Phone:787-795-3350
Mailing Address - Fax:787-784-0680
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:SEPTIMA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-3350
Practice Address - Fax:787-784-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care