Basic Information
Provider Information
NPI: 1053844993
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OCASIO
FirstName: LUIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: CENTRO MEDICO RIO PIEDRAS
Address2: HOSPITAL ONCOLOGICO DR. I. GONZALEZ MARTINEZ
City: SAN JUAN
State: PR
PostalCode: 00926
CountryCode: US
TelephoneNumber: 7877634149
FaxNumber:  
Practice Location
Address1: CENTRO MEDICO RIO PIEDRAS
Address2: HOSPITAL ONCOLOGICO DR. I. GONZALEZ MARTINEZ
City: SAN JUAN
State: PR
PostalCode: 00926
CountryCode: US
TelephoneNumber: 7877634149
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/07/2017
LastUpdateDate: 04/07/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X11481IPRY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


Home