1740557503 NPI number — CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL SUR, CSP

Table of content: (NPI 1740557503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740557503 NPI number — CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL SUR, CSP

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL SUR, CSP
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:
1740557503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 937
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COAMO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00769-0937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-845-0805
Provider Business Mailing Address Fax Number:
787-845-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR. 153 KM 7.5, PLAZA SANTA ISABEL, LOCAL 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ISABEL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00757-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-845-0805
Provider Business Practice Location Address Fax Number:
787-845-0806
Provider Enumeration Date:
11/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MATOS
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-479-2608

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X , with the licence number:  16901 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0200X , with the licence number: 16901 , 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)





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