1265440788 NPI number — CLINICA DE CANCER Y ENFERMEDAQDES

Table of content: (NPI 1265440788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265440788 NPI number — CLINICA DE CANCER Y ENFERMEDAQDES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE CANCER Y ENFERMEDAQDES
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:
CLINICA DE CANCER Y ENFERMEDADES DE LA SANGRE, CSP
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:
1265440788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00605-5191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-882-3975
Provider Business Mailing Address Fax Number:
787-997-0123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. CAIMITAL BAJO, AVENIDA SEVERIANO CUEVAS #18
Provider Second Line Business Practice Location Address:
HOSPITAL BUEN SAMARITANO
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-882-3975
Provider Business Practice Location Address Fax Number:
787-997-0123
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
JOSE
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-882-3975

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  10679 , 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)

  • Identifier: 40D0944775 . This is a "CLIA ID NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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