Healthcare Provider Details

I. General information

NPI: 1063804680
Provider Name (Legal Business Name): CENTRO ONCOLOGICO DE CAYEY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 73 BOX 6440
CAYEY PR
00736-9529
US

IV. Provider business mailing address

HC 73 BOX 6440
CAYEY PR
00736-9529
US

V. Phone/Fax

Practice location:
  • Phone: 787-214-5921
  • Fax:
Mailing address:
  • Phone: 787-214-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number17646
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number17646
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. OMAYRA REYES SANTIAGO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-214-5921