MEDICARE: CARLOS R MOYKA DBA CRM GROUP PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		PR

General Provider Information

NPI Number	:	1164455150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS R MOYKA DBA CRM GROUP PRACTICE

Provider Business Mailing Address
First Line	:	PO BOX 51083
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00950-1083
Country	:	US
Telephone Number	:	787-795-2935
Fax Number	:	787-784-0680

Provider Business Practice Location Address
First Line	:	HF16 CALLE LIZZIE GRAHAM
Second Line	:	7TH SECTION LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-3634
Country	:	US
Telephone Number	:	787-795-2935
Fax Number	:	787-784-0680

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CARLOS R MOYKA
Credential	:	M.D.
Telephone Number	:	787-795-4810

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	01/28/2009

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