Healthcare Provider Details

I. General information

NPI: 1245561976
Provider Name (Legal Business Name): GRUPO ONCOLOGICO COMUNITARIO DE SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON SUITE 517
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 AVE PONCE DE LEON SUITE 517
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-0314
  • Fax: 787-767-0493
Mailing address:
  • Phone: 787-274-3387
  • Fax: 787-767-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. ZASHA LEE FELICIANO
Title or Position: MEDICAL BILLING
Credential:
Phone: 787-281-0314