Provider Demographics
NPI:1942656350
Name:MARALEC,CSP
Entity Type:Organization
Organization Name:MARALEC,CSP
Other - Org Name:INSTITUTO ONCOLOGIA MODERNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-848-0606
Mailing Address - Street 1:PO BOX 7105
Mailing Address - Street 2:PMB 595
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7105
Mailing Address - Country:US
Mailing Address - Phone:787-848-0606
Mailing Address - Fax:787-848-0616
Practice Address - Street 1:35 CALLE CASTILLO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3747
Practice Address - Country:US
Practice Address - Phone:787-848-0606
Practice Address - Fax:787-848-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13250261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$OtherSOCIAL SECURITY
PRI17721Medicare UPIN
PR1114961091Medicare PIN