Healthcare Provider Details

I. General information

NPI: 1861100703
Provider Name (Legal Business Name): BIOMOLECULAR PERSONAL CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CALLE JOSE C VAZQUEZ
AIBONITO PR
00705-3309
US

IV. Provider business mailing address

PO BOX 372350
CAYEY PR
00737-2350
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-4404
  • Fax:
Mailing address:
  • Phone: 787-735-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIDAL ROSARIO LEON
Title or Position: PRESIDENT
Credential: MD
Phone: 787-735-4404