Provider Demographics
NPI:1184273575
Name:GRUPO MEDICO INTEGRADO DE CANCER DE PUERTO RICO LLC
Entity type:Organization
Organization Name:GRUPO MEDICO INTEGRADO DE CANCER DE PUERTO RICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-263-0411
Mailing Address - Street 1:PO BOX 371763
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MORALES ESQ SALVADOR BRAU
Practice Address - Street 2:SUITE 2-3
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-0411
Practice Address - Fax:787-263-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty