Provider Demographics
NPI:1245561976
Name:GRUPO ONCOLOGICO COMUNITARIO DE SAN JUAN
Entity Type:Organization
Organization Name:GRUPO ONCOLOGICO COMUNITARIO DE SAN JUAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZASHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-281-0314
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 517
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-274-3387
Mailing Address - Fax:787-767-0493
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 517
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-281-0314
Practice Address - Fax:787-767-0493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRUPO ONCOLOGICO COMUNITARIO DE SAN JUAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084661Medicare PIN