Healthcare Provider Details

I. General information

NPI: 1225794589
Provider Name (Legal Business Name): PRECISION ONCOLOGY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA CASA SUITE 101 1507 PONCE DE LEON AVENUE
SAN JUAN PR
00909
US

IV. Provider business mailing address

PO BOX 9022971
SAN JUAN PR
00902-2971
US

V. Phone/Fax

Practice location:
  • Phone: 787-407-3333
  • Fax:
Mailing address:
  • Phone: 787-407-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SX0204X
TaxonomyPediatric Oncology Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. GABRIELA HERRANS MAYA
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-420-5600