Healthcare Provider Details

I. General information

NPI: 1306139993
Provider Name (Legal Business Name): CARIBBEAN CANCER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BY PASS EDIFICIO PARRA SUITE 101
PONCE PR
00717
US

IV. Provider business mailing address

2225 PONCE BY PASS EDIFICIO PARRA SUITE 101
PONCE PR
00717
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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