Healthcare Provider Details

I. General information

NPI: 1528249265
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: 11/23/2007
Last Update Date: 05/13/2024
Certification Date: 05/03/2024
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
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
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