Healthcare Provider Details

I. General information

NPI: 1689836629
Provider Name (Legal Business Name): CENTRO DE CANCER DE LA UNIVERSIDAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/09/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO JOSE CELSO BARBOSA CENTRO DE RADIOTERAPIA CCCUPR
SAN JUAN PR
00927
US

IV. Provider business mailing address

PO BOX 363027
SAN JUAN PR
00936-3027
US

V. Phone/Fax

Practice location:
  • Phone: 787-200-3220
  • Fax:
Mailing address:
  • Phone: 787-772-8300
  • Fax: 787-758-2557

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 Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE BUZAINZ
Title or Position: ADMINISTRATOR
Credential: MHSA
Phone: 787-772-8300