Healthcare Provider Details

I. General information

NPI: 1679900567
Provider Name (Legal Business Name): CARIBBEAN CANCER CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS EDIFICIO PAUA SUITE 706
PONCE PR
00717
US

IV. Provider business mailing address

2225 PONCE BY PASS EDIFICIO PARRA SUITE 706
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-4830
  • Fax: 787-841-1149
Mailing address:
  • Phone: 787-284-4830
  • Fax: 787-841-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROLANDO L JIMENEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-284-4830