Provider Demographics
NPI:1174954481
Name:CENTRO ONCOLOGICO DE LA MUJER DE PUERTO RICO CSP
Entity type:Organization
Organization Name:CENTRO ONCOLOGICO DE LA MUJER DE PUERTO RICO CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DI MARCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-548-8412
Mailing Address - Street 1:609 AVE TITO CASTRO STE 102
Mailing Address - Street 2:PMB 359
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-548-8412
Mailing Address - Fax:787-651-6303
Practice Address - Street 1:1378 CALLE SALUD
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2004
Practice Address - Country:US
Practice Address - Phone:787-813-3552
Practice Address - Fax:787-984-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16950261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology