1518364686 NPI number — COMPREHENSIVE CANCER SPECIALISTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518364686 NPI number — COMPREHENSIVE CANCER SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE CANCER SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518364686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 WASHINGTON STREET
Provider Second Line Business Mailing Address:
STE 601-602 ASHFORD MEDICAL CTR
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-249-9560
Provider Business Mailing Address Fax Number:
509-275-5604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
STE 601-602 ASHFORD MEDICAL CTR
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-249-9560
Provider Business Practice Location Address Fax Number:
509-275-5604
Provider Enumeration Date:
12/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ RIVERA
Authorized Official First Name:
ANGEL
Authorized Official Middle Name:
MIGUEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-782-9999

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  18873 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: 18873 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)