Provider Demographics
NPI:1588916274
Name:LIGA PUERTORRIQUENA CONTRA EL CANCER
Entity type:Organization
Organization Name:LIGA PUERTORRIQUENA CONTRA EL CANCER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL INTERN
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ELFREN
Authorized Official - Last Name:CINTRON ORTIZ
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:787-763-4149
Mailing Address - Street 1:CENTRO MEDICO RIO PIEDRA
Mailing Address - Street 2:BO MONACILLOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-763-4149
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO RIO PIEDRA
Practice Address - Street 2:BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014395281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital