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General NPI Number Information
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NPI Number | 1174954481
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Entity Type | Organization
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Legal Business Name | CENTRO ONCOLOGICO DE LA MUJER DE PUERTO RICO CSP
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 1378 CALLE SALUD
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City | PONCE
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State | PR
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Zip | 00717-2004
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Country | US
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Telephone | 787-813-3552
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Fax | 787-984-3552
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Provider Business Mailing Address
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Address Line | 609 AVE TITO CASTRO STE 102 PMB 359
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City | PONCE
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State | PR
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Zip | 00716-0200
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Country | US
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Telephone | 787-548-8412
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Fax | 787-651-6303
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANNA MARIA DI MARCO
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Credential | MD
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Telephone | 787-548-8412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | 16950
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License Number State | PR
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