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General NPI Number Information
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NPI Number | 1598089765
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Entity Type | Organization
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Legal Business Name | GYN-ONCOLOGY GROUP,PSC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | AUXILIO CENTRO DE CANCER, 715 PONCE DE LEON AV PARADA 37 1/2 ,EDIF. NINO JESUS 4TO PISO
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City | HATO REY
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State | PR
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Zip | 00919
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Country | US
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Telephone | 805-405-3660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 362422
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City | SAN JUAN
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State | PR
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Zip | 00936-2422
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Country | US
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Telephone | 805-405-3660
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS J SANTOS REYES
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Credential | M.D.
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Telephone | 805-405-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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