1215418751 NPI number — CENTRO DE CANCER DE LA UNIVERSIDAD

Table of content: (NPI 1215418751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215418751 NPI number — CENTRO DE CANCER DE LA UNIVERSIDAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE CANCER DE LA UNIVERSIDAD
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:
GRUPO MEDICO CENTRO COMPRENSIVO DE CANCER
Provider Other Organization Name Type Code:
3
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:
1215418751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363027
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:
00936-3027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-772-8300
Provider Business Mailing Address Fax Number:
787-936-1491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR 21 INT PR18
Provider Second Line Business Practice Location Address:
BO 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:
00927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-772-8300
Provider Business Practice Location Address Fax Number:
787-936-1471
Provider Enumeration Date:
08/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
BENITEZ-CHACON
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
CARLOS
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-772-8300

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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