Provider Demographics
NPI:1275845851
Name:ADVANCE ONCOLOGY
Entity Type:Organization
Organization Name:ADVANCE ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARY
Authorized Official - Prefix:
Authorized Official - First Name:MEILEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ORTEGA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-466-8213
Mailing Address - Street 1:CALLE 1 K1
Mailing Address - Street 2:MANSIONES DE VILLA NOVA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0000
Mailing Address - Country:US
Mailing Address - Phone:787-466-8213
Mailing Address - Fax:
Practice Address - Street 1:AVE PEDRO ALBIZUS CAMPO
Practice Address - Street 2:NUM 150 REPARTO LOPEZ
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0000
Practice Address - Country:US
Practice Address - Phone:787-466-8213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14159261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCF891AMedicare PIN