Provider Demographics
NPI:1134556079
Name:ANGELUZ ONCOLOGY STORE, INC
Entity type:Organization
Organization Name:ANGELUZ ONCOLOGY STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:CFOM0538
Authorized Official - Phone:787-722-4803
Mailing Address - Street 1:804 CALLE LAFAYETTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2626
Mailing Address - Country:US
Mailing Address - Phone:787-722-4803
Mailing Address - Fax:787-721-3399
Practice Address - Street 1:804 CALLE LAFAYETTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2626
Practice Address - Country:US
Practice Address - Phone:787-722-4803
Practice Address - Fax:787-721-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03387450012332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies