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Organization
CENTRO DE RADIOTERAPIA AUXILIO MUTUO, INC.
Active
Organization
CENTRO DE RADIOTERAPIA AUXILIO MUTUO, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORGE LUIS MATTA MHSA (ADMINISTRATOR)
(787) 758-2000
Entity
Organization
Contact information
Practice address
735 AVE PONCE DE LEON, STOP 37.5, SAN JUAN, PR 00917-5022
(787) 771-7934
(787) 771-7402
Mailing address
PO BOX 191227, SAN JUAN, PR 00919-1227
(787) 771-7934
(787) 771-7402
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100593
CRUZ AZUL
PR
01
—
660312302
MAPFRE
PR
01
—
7582
PALIC
PR
01
—
9190184
HUMANA
PR
Enumeration date
05/04/2006
Last updated
07/18/2016
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