Provider Demographics
NPI:1215008644
Name:CCM CAYEY, CSP.
Entity Type:Organization
Organization Name:CCM CAYEY, CSP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:ROBLES-CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-263-0411
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 472
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-263-0411
Mailing Address - Fax:787-263-0970
Practice Address - Street 1:EDIF PROFESIONAL MENONITA
Practice Address - Street 2:SUITE 202
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-0000
Practice Address - Country:US
Practice Address - Phone:787-263-0411
Practice Address - Fax:787-263-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0010383Medicare ID - Type Unspecified