Healthcare Provider Details

I. General information

NPI: 1992073233
Provider Name (Legal Business Name): SOUTH CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MED SAN LUCAS 5TO PISO OFICINA 508
PONCE PR
00716-4728
US

IV. Provider business mailing address

609 AVE TITO CASTRO SUITE 102 PMB 464
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-6010
  • Fax: 787-651-6309
Mailing address:
  • Phone: 787-651-6010
  • Fax: 787-651-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number14399
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE I RODRIGUEZ LUGO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-651-6010