Provider Demographics
NPI:1992129001
Name:CRP PHYSICIAN SERVICES
Entity type:Organization
Organization Name:CRP PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NILO
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:786-426-9716
Mailing Address - Street 1:7400 NW 7TH ST
Mailing Address - Street 2:B111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2942
Mailing Address - Country:US
Mailing Address - Phone:786-426-9716
Mailing Address - Fax:
Practice Address - Street 1:7400 NW 7TH ST
Practice Address - Street 2:B111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2942
Practice Address - Country:US
Practice Address - Phone:786-426-9716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization