Healthcare Provider Details

I. General information

NPI: 1679995575
Provider Name (Legal Business Name): FUNDACION ONCOLOGY NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 AVE MUNOZ RIVERA RIO PIEDRAS
SAN JUAN PR
00927-4308
US

IV. Provider business mailing address

998 AVE MUNOZ RIVERA RIO PIEDRAS
SAN JUAN PR
00927-4308
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-1248
  • Fax: 787-721-6098
Mailing address:
  • Phone: 787-722-1248
  • Fax: 787-721-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIBEL RODRIGUEZ TORRES
Title or Position: MANAGER
Credential: MD
Phone: 787-722-1248