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General NPI Number Information
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NPI Number | 1689018723
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Entity Type | Organization
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Legal Business Name | BREAST CANCER CARE, CSP
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | TORRE MED SAN LUCAS , SUITES 508-509
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City | PONCE
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State | PR
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Zip | 00716-4728
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Country | US
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Telephone | 787-651-6010
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Fax | 787-651-6309
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Provider Business Mailing Address
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Address Line | 609 AVE TITO CASTRO SUITE 102 PMB 464
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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 | 787-651-6010
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Fax | 787-651-6309
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE I RODRIGUEZ LUGO
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Credential | MD
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Telephone | 787-651-6010
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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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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 14399
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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