Healthcare Provider Details

I. General information

NPI: 1588916274
Provider Name (Legal Business Name): LIGA PUERTORRIQUENA CONTRA EL CANCER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO MEDICO RIO PIEDRA BO MONACILLOS
SAN JUAN PR
00926
US

IV. Provider business mailing address

CENTRO MEDICO RIO PIEDRA BO MONACILLOS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-4149
  • Fax:
Mailing address:
  • Phone: 787-763-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number014395
License Number StatePR

VIII. Authorized Official

Name: DR. LUIS ELFREN CINTRON ORTIZ III
Title or Position: MEDICAL INTERN
Credential: M.D.
Phone: 787-763-4149