MEDICARE: CENTRO BAQUITERAPIA AVANZADA

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	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1578674719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO BAQUITERAPIA AVANZADA

Provider Business Mailing Address
First Line	:	PO BOX 16667
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00908-6667
Country	:	US
Telephone Number	:	787-767-1780
Fax Number	:	787-274-1851

Provider Business Practice Location Address
First Line	:	500 AVE DOMENECH STE 503
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3709
Country	:	US
Telephone Number	:	767-767-1780
Fax Number	:	787-274-1851

Authorized Official
Title or Position	:	OWNER
Name	:	MARIANO SOCARRAZ
Credential	:
Telephone Number	:	787-767-1780

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/21/2022

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