Healthcare Provider Details

I. General information

NPI: 1013463777
Provider Name (Legal Business Name): SERVICIOS MEDICOS ESPECIALIZADOSDE LEVITTOWN CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 AVE DOS PALMAS SUITE 101
TOA BAJA PR
00949-1911
US

IV. Provider business mailing address

PO BOX 51911
TOA BAJA PR
00950-1911
US

V. Phone/Fax

Practice location:
  • Phone: 787-261-6199
  • Fax: 787-261-3552
Mailing address:
  • Phone: 787-261-6199
  • Fax: 787-261-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10706
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10397
License Number StatePR

VIII. Authorized Official

Name: DR. RODOLFO OROZCO
Title or Position: PRESIDENT
Credential: M.D
Phone: 787-635-4092