Provider Demographics
NPI:1013298942
Name:INSTITUTO DE RADIOTERAPIA DEL ESTE, PSC
Entity Type:Organization
Organization Name:INSTITUTO DE RADIOTERAPIA DEL ESTE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:RENTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-719-2300
Mailing Address - Street 1:55 CALLE ANTONIO LOPEZ S
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4202
Mailing Address - Country:US
Mailing Address - Phone:787-719-2300
Mailing Address - Fax:787-719-2317
Practice Address - Street 1:55 CALLE ANTONIO LOPEZ S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4202
Practice Address - Country:US
Practice Address - Phone:787-719-2300
Practice Address - Fax:787-719-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QX0203X
261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation