Provider Demographics
NPI:1205122801
Name:ONCOLOGY HEALTH ALLIANCE GR, P.S.C.
Entity type:Organization
Organization Name:ONCOLOGY HEALTH ALLIANCE GR, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-866-1500
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0000
Mailing Address - Country:US
Mailing Address - Phone:787-866-1500
Mailing Address - Fax:787-866-1570
Practice Address - Street 1:CARR. 14 KM 0.3
Practice Address - Street 2:HOSP. MENONITA CAYEY - OFIC. CTRO MEDICO NUCLEAR
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-0000
Practice Address - Country:US
Practice Address - Phone:787-866-1500
Practice Address - Fax:787-866-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology