Healthcare Provider Details

I. General information

NPI: 1265440788
Provider Name (Legal Business Name): CLINICA DE CANCER Y ENFERMEDADES DE LA SANGRE, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 460 KM 0.2 BO CAIMITAL BAJO
AGUADILLA PR
00603-4055
US

IV. Provider business mailing address

PO BOX 5191
AGUADILLA PR
00605-5191
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-3975
  • Fax: 787-997-0123
Mailing address:
  • Phone: 787-882-3975
  • Fax: 787-997-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number10679
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTOR J VAZQUEZ-RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-882-3975