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NPI Code Detail

MEDICARE: LIGA PUERTORRIQUENA CONTRA EL CANCER

MEDICARE: LIGA PUERTORRIQUENA CONTRA EL CANCER
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
1284300000XSpecial Hospital#65PR
2284300000XSpecial Hospital

General Provider Information

NPI Number : 1407852338
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGA PUERTORRIQUENA CONTRA EL CANCER
Provider Business Mailing Address
First Line : PO BOX 191811
Second Line :
City : SAN JUAN
State : PR
Zip : 00919-1811
Country : US
Telephone Number : 787-763-4149
Fax Number : 787-641-4601
Provider Business Practice Location Address
First Line : BO MONACILLOS 150 AVE AMERICO MIRANDA
Second Line : AREA CENTRO MEDICO METROPOLITANO
City : SAN JUAN
State : PR
Zip : 00935-0001
Country : US
Telephone Number : 787-763-4149
Fax Number : 787-641-4601
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JORGE DE JESUS ROZAS SR.
Credential : MHSA
Telephone Number : 787-763-4149
Provider Enumeration Date : 06/24/2005
Last Update Date : 06/27/2013

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Directions to “LIGA PUERTORRIQUENA CONTRA EL CANCER ” Practice Location

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