Provider Demographics
NPI:1104251172
Name:CENTRO DE SERVICIOS MEDICOS INC
Entity type:Organization
Organization Name:CENTRO DE SERVICIOS MEDICOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROIG
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:787-795-2935
Mailing Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Mailing Address - Street 2:SEPTIMA SECCION LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-3634
Mailing Address - Country:US
Mailing Address - Phone:787-795-2935
Mailing Address - Fax:787-784-0680
Practice Address - Street 1:HF16 CALLE LIZZIE GRAHAM
Practice Address - Street 2:SEPTIMA SECCION LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3634
Practice Address - Country:US
Practice Address - Phone:787-795-2935
Practice Address - Fax:787-784-0680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE SERVICIOS MEDICOS DE LEVITTOWN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-10
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty