Provider Demographics
NPI:1750872099
Name:CENTRO DE MEDICINA ONCOLOGICA DE PUERTO RICO, CSP
Entity type:Organization
Organization Name:CENTRO DE MEDICINA ONCOLOGICA DE PUERTO RICO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOLALBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENO-ORENGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-314-1909
Mailing Address - Street 1:478 CAMINO DE LA VEGA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-3639
Mailing Address - Country:US
Mailing Address - Phone:787-858-1635
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 K 39.5
Practice Address - Street 2:HOSPITAL WILMA N VAZQUEZ OFICINA 108
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694
Practice Address - Country:US
Practice Address - Phone:787-363-7652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19067207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty