Healthcare Provider Details

I. General information

NPI: 1760972756
Provider Name (Legal Business Name): SAN CRISTOBAL ONCOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TITO CASTRO BLVD
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 801211
COTO LAUREL PR
00780-1211
US

V. Phone/Fax

Practice location:
  • Phone: 787-648-5057
  • Fax:
Mailing address:
  • Phone: 787-648-5057
  • Fax: 787-848-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number18-050
License Number StatePR

VIII. Authorized Official

Name: MRS. HAEDIE JAMILLE RAMOS
Title or Position: BILLING DIRECTOR
Credential:
Phone: 787-848-2100