Healthcare Provider Details

I. General information

NPI: 1164455150
Provider Name (Legal Business Name): CARLOS R MOYKA DBA CRM GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM 7TH SECTION LEVITTOWN
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

PO BOX 51083
TOA BAJA PR
00950-1083
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax: 787-784-0680
Mailing address:
  • Phone: 787-795-2935
  • Fax: 787-784-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS R MOYKA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 787-795-4810