MEDICARE: CENTRO ONCOLOGIA Y HEMATOLOGIA

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	6441	PR

General Provider Information

NPI Number	:	1518063098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO ONCOLOGIA Y HEMATOLOGIA

Provider Business Mailing Address
First Line	:	PO BOX 363986
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-3986
Country	:	US
Telephone Number	:	787-751-0373
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 AVE PONCE DE LEON
Second Line	:	SUITE 416
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4509
Country	:	US
Telephone Number	:	787-751-0373
Fax Number	:

Authorized Official
Title or Position	:	NURSE
Name	:	MRS. DALIA RUIZ
Credential	:
Telephone Number	:	787-751-0373

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/22/2020

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