Provider Demographics
| NPI: | 1215418751 |
|---|---|
| Name: | CENTRO DE CANCER DE LA UNIVERSIDAD |
| Entity Type: | Organization |
| Organization Name: | CENTRO DE CANCER DE LA UNIVERSIDAD |
| Other - Org Name: | GRUPO MEDICO CENTRO COMPRENSIVO DE CANCER |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JUAN |
| Authorized Official - Middle Name: | CARLOS |
| 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: | 787-936-1491 |
| Practice Address - Street 1: | PR 21 INT PR18 |
| Practice Address - Street 2: | BO MONACILLO |
| 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: | 787-936-1471 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | CENTRO DE CANCER DE LA UNIVERSIDAD |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2018-08-23 |
| Last Update Date: | 2022-07-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
