Basic Information
| Provider Information | |||||||||
| NPI: | 1588916274 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIGA PUERTORRIQUENA CONTRA EL CANCER | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOSPITAL ONCOLOGICO DR. I GONZALES MARTINEZ | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | CENTRO MEDICO RIO PIEDRA | ||||||||
| Address2: | BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CENTRO MEDICO RIO PIEDRA | ||||||||
| Address2: | BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2012 | ||||||||
| LastUpdateDate: | 10/05/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CINTRON ORTIZ | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | ELFREN | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL INTERN | ||||||||
| AuthorizedOfficialTelephone: | 7877634149 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281P00000X | 014395 | PR | Y | Hospitals | Chronic Disease Hospital |
No ID Information.