1962654913 NPI number — HOPSITAL ONCOLOGICO DR. ISAAC GONZALEZ MARTINEZ

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 1962654913 NPI number — HOPSITAL ONCOLOGICO DR. ISAAC GONZALEZ MARTINEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPSITAL ONCOLOGICO DR. ISAAC GONZALEZ MARTINEZ
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:
HOSPITAL MUNICIPAL DE JUNCOS
Provider Other Organization Name Type Code:
5
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:
1962654913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191811
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00919-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO MEDICO RIO PIEDRAS
Provider Second Line Business Practice Location Address:
BARRRIO MONACILLO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-763-4149
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
ROSALY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
GENERAL PRACTITIONER
Authorized Official Telephone Number:
787-734-0494

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  17739 , 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)





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