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General NPI Number Information
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NPI Number | 1861100703
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Entity Type | Organization
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Legal Business Name | BIOMOLECULAR PERSONAL CANCER CENTER LLC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 108 CALLE JOSE C VAZQUEZ
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City | AIBONITO
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State | PR
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Zip | 00705-3309
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Country | US
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Telephone | 787-735-4404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 372350
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City | CAYEY
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State | PR
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Zip | 00737-2350
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Country | US
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Telephone | 787-735-4404
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIDAL ROSARIO LEON
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Credential | MD
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Telephone | 787-735-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology 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 | 208600000X
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Taxonomy Name | Surgery Physician
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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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZC0006X
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Taxonomy Name | Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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