1750780466 NPI number — CANCER CENTER OF THE CARIBBEAN, LLC

Table of content: (NPI 1750780466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750780466 NPI number — CANCER CENTER OF THE CARIBBEAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CENTER OF THE CARIBBEAN, LLC
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:
6
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:
1750780466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8520
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:
00910-0520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-562-5168
Provider Business Mailing Address Fax Number:
787-722-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 PONCE DE LEON EDIF MIDTOWN
Provider Second Line Business Practice Location Address:
SUITE 805
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-919-7690
Provider Business Practice Location Address Fax Number:
787-919-7694
Provider Enumeration Date:
08/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
ELOISA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-934-1838

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 340921 . This is a "REGISTRATION" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com