Provider Demographics
NPI:1861100703
Name:BIOMOLECULAR PERSONAL CANCER CENTER LLC
Entity type:Organization
Organization Name:BIOMOLECULAR PERSONAL CANCER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-735-4404
Mailing Address - Street 1:PO BOX 372350
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2350
Mailing Address - Country:US
Mailing Address - Phone:787-735-4404
Mailing Address - Fax:
Practice Address - Street 1:108 CALLE JOSE C VAZQUEZ
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3309
Practice Address - Country:US
Practice Address - Phone:787-735-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty