MEDICARE: GRUPO MEDICO CRESPO OROZCO PSC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1659706968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRUPO MEDICO CRESPO OROZCO PSC

Provider Business Mailing Address
First Line	:	TRINITARIA 269
Second Line	:	CIUDAD JARDIN
City	:	CAROLINA
State	:	PR
Zip	:	00987
Country	:	US
Telephone Number	:	787-256-2853
Fax Number	:	787-876-2445

Provider Business Practice Location Address
First Line	:	978 CALLE BAUHINIA
Second Line	:	LOIZA VALLEY
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3410
Country	:	US
Telephone Number	:	787-256-2853
Fax Number	:	787-876-2445

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROLANDO CRESPO
Credential	:	M.D.
Telephone Number	:	787-256-2853

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/05/2013

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