Healthcare Provider Details

I. General information

NPI: 1225020662
Provider Name (Legal Business Name): CENTRO DE CANCER DE LA MONTANA CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOSE C. VAZQUEZ #1 DR. TROCHE KM 4 INTERIOR, CARR. 726
AIBONITO PR
00705
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 472
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-1888
  • Fax: 787-735-2080
Mailing address:
  • Phone: 787-740-3230
  • Fax: 787-993-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM SIERRA
Title or Position: DIRECTOR RH
Credential:
Phone: 787-740-3230