Provider Demographics
NPI:1174397251
Name:ISLAND GYNECOLOGIC ONCOLOGY LLC
Entity type:Organization
Organization Name:ISLAND GYNECOLOGIC ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FIORELLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYES BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-509-9970
Mailing Address - Street 1:690 CALLE CESAR GONZALEZ APT 701
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3903
Mailing Address - Country:US
Mailing Address - Phone:787-509-9970
Mailing Address - Fax:
Practice Address - Street 1:TORRE AUXILIO MUTUO AVE PONCE DE LEON 715
Practice Address - Street 2:SUITE 812
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-509-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty