Provider Demographics
NPI:1164455150
Name:CARLOS R MOYKA DBA CRM GROUP PRACTICE
Entity Type:Organization
Organization Name:CARLOS R MOYKA DBA CRM GROUP PRACTICE
Other - Org Name:CRM GROUP PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
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:MD
Authorized Official - Phone:787-795-4810
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:787-795-2935
Mailing Address - Fax:787-784-0680
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:7TH SECTION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:787-784-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080131Medicare ID - Type UnspecifiedMEDICARE GROUP ID