Provider Demographics
NPI:1720069925
Name:JOSE A CEBOLLERO MARCUCCI - SURGICAL ONCOLOGY PSC
Entity Type:Organization
Organization Name:JOSE A CEBOLLERO MARCUCCI - SURGICAL ONCOLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CEBOLLERO MARCUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-866-7409
Mailing Address - Street 1:PO BOX 2039
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2039
Mailing Address - Country:US
Mailing Address - Phone:787-866-7409
Mailing Address - Fax:787-886-7409
Practice Address - Street 1:HOSPITAL EPISCOPAL CRISTO REDENTOR
Practice Address - Street 2:SUITE 101
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-866-7409
Practice Address - Fax:787-886-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9035208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Not Answered2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E77313Medicare UPIN