MEDICARE: DR. JOSE A CANCIO M.D.

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	174400000X	Specialist	13997	PR

General Provider Information

NPI Number	:	1750388542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE A CANCIO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1430
Second Line	:
City	:	HORMIGUEROS
State	:	PR
Zip	:	00660-5430
Country	:	US
Telephone Number	:	787-806-2600
Fax Number	:	787-806-2656

Provider Business Practice Location Address
First Line	:	MEDICAL EMPORIUM II SUITE 1A
Second Line	:	349 HOSTOS AVENUE
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682
Country	:	US
Telephone Number	:	787-806-2600
Fax Number	:	787-806-2656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/01/2017

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