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General NPI Number Information
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NPI Number | 1174397251
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Entity Type | Organization
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Legal Business Name | ISLAND GYNECOLOGIC ONCOLOGY LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | TORRE AUXILIO MUTUO AVE PONCE DE LEON 715 SUITE 812
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-509-9970
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Fax |
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Provider Business Mailing Address
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Address Line | 690 CALLE CESAR GONZALEZ APT 701
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City | SAN JUAN
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State | PR
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Zip | 00918-3903
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Country | US
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Telephone | 787-509-9970
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FIORELLA E REYES BAEZ
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Credential |
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Telephone | 787-509-9970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State |
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