Provider Demographics
NPI:1659571289
Name:CENTRO QUIMOTERAPEUTICO DEL CARIBE
Entity Type:Organization
Organization Name:CENTRO QUIMOTERAPEUTICO DEL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:PESQUERA-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-728-1193
Mailing Address - Street 1:PO BOX 19921
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1921
Mailing Address - Country:US
Mailing Address - Phone:787-728-1193
Mailing Address - Fax:787-726-4244
Practice Address - Street 1:SANTURCE MEDICAL MALL STE 309-310
Practice Address - Street 2:AVE. PONCE DE LEON 1801
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-728-1193
Practice Address - Fax:787-726-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7279305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79806Medicare UPIN