Provider Demographics
NPI:1013463777
Name:SERVICIOS MEDICOS ESPECIALIZADOSDE LEVITTOWN CSP
Entity type:Organization
Organization Name:SERVICIOS MEDICOS ESPECIALIZADOSDE LEVITTOWN CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-635-4092
Mailing Address - Street 1:PO BOX 51911
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1911
Mailing Address - Country:US
Mailing Address - Phone:787-261-6199
Mailing Address - Fax:787-261-3552
Practice Address - Street 1:2765 AVE DOS PALMAS
Practice Address - Street 2:SUITE 101
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-1911
Practice Address - Country:US
Practice Address - Phone:787-261-6199
Practice Address - Fax:787-261-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103972084P0800X
PR10706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1730170010OtherNPI
PR1659362895OtherNPI