Healthcare Provider Details

I. General information

NPI: 1346436607
Provider Name (Legal Business Name): JOSE A CEBOLLERO MARCUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL SAN LUCAS GUAYAMA SUITE 101
GUAYAMA PR
00784
US

IV. Provider business mailing address

PO BOX 2039
GUAYAMA PR
00785-2039
US

V. Phone/Fax

Practice location:
  • Phone: 787-376-6423
  • Fax:
Mailing address:
  • Phone: 787-866-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number9035
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: