Provider Demographics
NPI:1982654513
Name:GRUPO ONCOLOGICO COMUNITARIO DE SAN JUAN PSC MEDICOS
Entity Type:Organization
Organization Name:GRUPO ONCOLOGICO COMUNITARIO DE SAN JUAN PSC MEDICOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-274-3387
Mailing Address - Street 1:735 AVE PONCE DE LEON
Mailing Address - Street 2:TORRE MEDICA AUXILIO MUTUO SUITE 517
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5022
Mailing Address - Country:US
Mailing Address - Phone:787-274-3387
Mailing Address - Fax:787-274-3389
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:TORRE MEDICA AUXLIO MUTUO SUITE 517
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-274-3387
Practice Address - Fax:787-374-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
PR6263261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084661Medicare PIN