Provider Demographics
NPI:1194274753
Name:PUERTO RICO ONCOLOGY GROUP
Entity type:Organization
Organization Name:PUERTO RICO ONCOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-385-8200
Mailing Address - Street 1:609 AVE TITO CASTRO
Mailing Address - Street 2:STE 102 PMB 464
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-385-8200
Mailing Address - Fax:
Practice Address - Street 1:5 AVENIDA HOSTOS SUR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-385-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14399OtherMEDICAL LICENSE