Healthcare Provider Details

I. General information

NPI: 1518364686
Provider Name (Legal Business Name): COMPREHENSIVE CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 07/01/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 WASHINGTON STREET STE 601-602 ASHFORD MEDICAL CTR
SAN JUAN PR
00907
US

IV. Provider business mailing address

29 WASHINGTON STREET STE 601-602 ASHFORD MEDICAL CTR
SAN JUAN PR
00907-1521
US

V. Phone/Fax

Practice location:
  • Phone: 787-249-9560
  • Fax: 509-275-5604
Mailing address:
  • Phone: 787-249-9560
  • Fax: 509-275-5604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18873
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number18873
License Number StatePR

VIII. Authorized Official

Name: DR. ANGEL MIGUEL RODRIGUEZ RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-782-9999