MEDICARE: CCM CAYEY, CSP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1215008644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCM CAYEY, CSP.

Provider Business Mailing Address
First Line	:	1353 AVE LUIS VIGOREAUX
Second Line	:	PMB 472
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2715
Country	:	US
Telephone Number	:	787-263-0411
Fax Number	:	787-263-0970

Provider Business Practice Location Address
First Line	:	EDIF PROFESIONAL MENONITA
Second Line	:	SUITE 202
City	:	CAYEY
State	:	PR
Zip	:	00736-0000
Country	:	US
Telephone Number	:	787-263-0411
Fax Number	:	787-263-0970

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NELSON ARIEL ROBLES-CARDONA
Credential	:	MD
Telephone Number	:	787-263-0411

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/23/2010

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