Provider Demographics
NPI:1003366527
Name:CENTRO DE CANCER DE LA UNIVERSIDAD
Entity Type:Organization
Organization Name:CENTRO DE CANCER DE LA UNIVERSIDAD
Other - Org Name:HOSPITAL CENTRO COMPRENSIVO DE CANCER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENITEZ-CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-772-8300
Mailing Address - Street 1:PO BOX 363027
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3027
Mailing Address - Country:US
Mailing Address - Phone:787-772-8300
Mailing Address - Fax:787-758-2557
Practice Address - Street 1:PR21 INT PR18
Practice Address - Street 2:BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-772-8300
Practice Address - Fax:787-758-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21OtherHOSPITAL LICENSE