Provider Demographics
NPI:1578674719
Name:CENTRO BAQUITERAPIA AVANZADA
Entity Type:Organization
Organization Name:CENTRO BAQUITERAPIA AVANZADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOCARRAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-767-1780
Mailing Address - Street 1:PO BOX 16667
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6667
Mailing Address - Country:US
Mailing Address - Phone:787-767-1780
Mailing Address - Fax:787-274-1851
Practice Address - Street 1:500 AVE DOMENECH STE 503
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3709
Practice Address - Country:US
Practice Address - Phone:767-767-1780
Practice Address - Fax:787-274-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20933Medicare ID - Type Unspecified