Provider Demographics
NPI:1962727370
Name:QUIMIO AMBDRV SERV. MED, C.S.P.
Entity type:Organization
Organization Name:QUIMIO AMBDRV SERV. MED, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-0587
Mailing Address - Street 1:2431 AVE. LAS AMERICAS
Mailing Address - Street 2:SUITE 105 EDIF. PORRATA PILA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2114
Mailing Address - Country:US
Mailing Address - Phone:787-841-0587
Mailing Address - Fax:787-842-2952
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:SUITE 105 EDIF. PORRATA PILA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-841-0587
Practice Address - Fax:787-842-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7161261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF01251Medicare UPIN