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General NPI Number Information
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NPI Number | 1174170765
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Entity Type | Organization
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Legal Business Name | LIGA PUERTORRIQUENA CONTRA EL CANCER
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 150 AVE AMERICO MIRANDA CENTRO MEDICO - BO MONACILLOS
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City | RIO PIEDRAS
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State | PR
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Zip | 00935
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Country | US
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Telephone | 787-652-2382
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Fax | 787-751-7940
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Provider Business Mailing Address
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Address Line | PO BOX 191811
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City | SAN JUAN
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State | PR
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Zip | 00919-1811
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Country | US
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Telephone | 787-765-2382
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Fax | 787-751-7940
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. YARISIS CENTENO SAUNDERS
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Credential |
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Telephone | 787-765-2382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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