Provider Demographics
NPI:1346659935
Name:BOARD CERTIFIED ONCOLOGY GROUP LLC
Entity Type:Organization
Organization Name:BOARD CERTIFIED ONCOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-919-7690
Mailing Address - Street 1:1519 AVE PONCE DE LEON
Mailing Address - Street 2:FIRST FEDERAL BUILDING
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-919-7690
Mailing Address - Fax:787-919-7694
Practice Address - Street 1:1519 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 1201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1703
Practice Address - Country:US
Practice Address - Phone:787-919-7690
Practice Address - Fax:787-919-7694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR340105OtherREGISTRO