Healthcare Provider Details

I. General information

NPI: 1720069925
Provider Name (Legal Business Name): JOSE A CEBOLLERO MARCUCCI - SURGICAL ONCOLOGY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL EPISCOPAL CRISTO REDENTOR SUITE 101
GUAYAMA PR
00785
US

IV. Provider business mailing address

PO BOX 2039
GUAYAMA PR
00785-2039
US

V. Phone/Fax

Practice location:
  • Phone: 787-866-7409
  • Fax: 787-886-7409
Mailing address:
  • Phone: 787-866-7409
  • Fax: 787-886-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9035
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number9035
License Number StatePR

VIII. Authorized Official

Name: MR. JOSE A CEBOLLERO MARCUCCI
Title or Position: PRESIDENT
Credential: MD
Phone: 787-866-7409