Healthcare Provider Details

I. General information

NPI: 1174954481
Provider Name (Legal Business Name): CENTRO ONCOLOGICO DE LA MUJER DE PUERTO RICO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 CALLE SALUD
PONCE PR
00717-2004
US

IV. Provider business mailing address

609 AVE TITO CASTRO STE 102 PMB 359
PONCE PR
00716-0200
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-3552
  • Fax: 787-984-3552
Mailing address:
  • Phone: 787-548-8412
  • Fax: 787-651-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number16950
License Number StatePR

VIII. Authorized Official

Name: DR. ANNA MARIA DI MARCO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-548-8412