Healthcare Provider Details

I. General information

NPI: 1811419575
Provider Name (Legal Business Name): CARIBBEAN WELLNESS ONCOLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 CALLE SALUD
PONCE PR
00717-2004
US

IV. Provider business mailing address

150 HWY. 873 VISTA DE LOS FRAILES STE. 70
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-3552
  • Fax: 787-984-3552
Mailing address:
  • Phone: 787-929-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number017967
License Number StatePR

VIII. Authorized Official

Name: DR. ERICK GUSTAVO CRUZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-929-9924