=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013463777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERVICIOS MEDICOS ESPECIALIZADOSDE LEVITTOWN CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2016
-----------------------------------------------------
Last Update Date | 08/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2765 AVE DOS PALMAS SUITE 101
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00949-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-261-6199
-----------------------------------------------------
Fax | 787-261-3552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51911
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00950-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-261-6199
-----------------------------------------------------
Fax | 787-261-3552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RODOLFO OROZCO
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 787-635-4092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 10397
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 10706
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------