Provider Demographics
NPI:1770851420
Name:CRT PROFESSIONAL MEDICAL SERVICES
Entity Type:Organization
Organization Name:CRT PROFESSIONAL MEDICAL SERVICES
Other - Org Name:CRT PROFESSIONAL MEDICAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-717-8690
Mailing Address - Street 1:698 CAMINO LOS CEDROS
Mailing Address - Street 2:VEREDAS DE NAVARRO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:939-717-8690
Mailing Address - Fax:
Practice Address - Street 1:698 CAMINO LOS CEDROS
Practice Address - Street 2:VEREDAS DE NAVARRO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:939-717-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty