1740313782 NPI number — ADVANCED HEMATOLOGY AND ONCOLOGY OF PUERTO RICO

Table of content: (NPI 1740313782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740313782 NPI number — ADVANCED HEMATOLOGY AND ONCOLOGY OF PUERTO RICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HEMATOLOGY AND ONCOLOGY OF PUERTO RICO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740313782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LUIS MUNOZ MARIN AVE
Provider Second Line Business Mailing Address:
HIMA SAN PABLO SUITE 907
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-744-8686
Provider Business Mailing Address Fax Number:
787-258-1125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE LUIS MUNOZ MARIN
Provider Second Line Business Practice Location Address:
HIMA SAN PABLO SUITE 907
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-8686
Provider Business Practice Location Address Fax Number:
787-258-1125
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
EDGARDO
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-744-8686

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  12477 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com