Healthcare Provider Details

I. General information

NPI: 1598075939
Provider Name (Legal Business Name): LIGA PUERTORRIQUENA CONTRA EL CANCER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AMERICO MIRANDA 150 CENTRO MEDICO
RIO PIEDRAS PR
00935-0000
US

IV. Provider business mailing address

PO BOX 191811
SAN JUAN PR
00919-1811
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-8433
  • Fax:
Mailing address:
  • Phone: 787-753-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ILIA GARCIA-DE RAMIREZ
Title or Position: PRESIDENT
Credential:
Phone: 787-753-8433