Provider Demographics
NPI:1407852338
Name:LIGA PUERTORRIQUENA CONTRA EL CANCER
Entity Type:Organization
Organization Name:LIGA PUERTORRIQUENA CONTRA EL CANCER
Other - Org Name:HOSPITAL ONCOLOGICO DR. ISSAC GONZALEZ MARTINEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS ROZAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-763-4149
Mailing Address - Street 1:PO BOX 191811
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1811
Mailing Address - Country:US
Mailing Address - Phone:787-763-4149
Mailing Address - Fax:787-641-4601
Practice Address - Street 1:BO MONACILLOS 150 AVE AMERICO MIRANDA
Practice Address - Street 2:AREA CENTRO MEDICO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:787-641-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#65284300000X
284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-0012Medicare ID - Type UnspecifiedMEDICARE # PROVIDER