Healthcare Provider Details

I. General information

NPI: 1962727370
Provider Name (Legal Business Name): QUIMIO AMBDRV SERV. MED, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS SUITE 105 EDIF. PORRATA PILA
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 AVE. LAS AMERICAS SUITE 105 EDIF. PORRATA PILA
PONCE PR
00717-2114
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-0587
  • Fax: 787-842-2952
Mailing address:
  • Phone: 787-841-0587
  • Fax: 787-842-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number7161
License Number StatePR

VIII. Authorized Official

Name: DR. ROBERTO VELAZQUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-841-0587