=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497014286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C&R MEDICAL SERVICES, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2012
-----------------------------------------------------
Last Update Date | 05/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | LOCAL AA-8 LOIZA VALLEY MALL
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-256-4541
-----------------------------------------------------
Fax | 787-256-7610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 200 PMB 359
-----------------------------------------------------
City | CANOVANAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00729-0200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-256-4541
-----------------------------------------------------
Fax | 787-256-7610
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | DR. DIEGO J COLON RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-256-4541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------