Provider Demographics
NPI:1952655268
Name:GYN ONCOLOGY GROUP PSC.
Entity Type:Organization
Organization Name:GYN ONCOLOGY GROUP PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:SANTOR-REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-487-3797
Mailing Address - Street 1:PO BOX 362422
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2422
Mailing Address - Country:US
Mailing Address - Phone:787-771-7942
Mailing Address - Fax:787-771-7423
Practice Address - Street 1:EDIT. DIVINO NINO JESUS, PISO PONCE DE LEON 715
Practice Address - Street 2:HOSPITAL AUXILIO MUTUO CENTRO DE CANCER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-771-7942
Practice Address - Fax:787-771-7423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15022207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty