1225020662 NPI number — CENTRO DE CANCER DE LA MONTANA CSP

Table of content: (NPI 1225020662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225020662 NPI number — CENTRO DE CANCER DE LA MONTANA CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE CANCER DE LA MONTANA CSP
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:
1225020662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1353 AVE LUIS VIGOREAUX
Provider Second Line Business Mailing Address:
PMB 472
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-740-3230
Provider Business Mailing Address Fax Number:
787-993-6010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JOSE C. VAZQUEZ #1 DR. TROCHE
Provider Second Line Business Practice Location Address:
KM 4 INTERIOR, CARR. 726
Provider Business Practice Location Address City Name:
AIBONITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-735-1888
Provider Business Practice Location Address Fax Number:
787-735-2080
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SIERRA
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR RH
Authorized Official Telephone Number:
787-740-3230

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; 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" .

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





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