Provider Demographics
NPI:1225020662
Name:CENTRO DE CANCER DE LA MONTANA CSP
Entity Type:Organization
Organization Name:CENTRO DE CANCER DE LA MONTANA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR RH
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-740-3230
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 472
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-740-3230
Mailing Address - Fax:787-993-6010
Practice Address - Street 1:JOSE C. VAZQUEZ #1 DR. TROCHE
Practice Address - Street 2:KM 4 INTERIOR, CARR. 726
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-1888
Practice Address - Fax:787-735-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10383Medicare PIN