Provider Demographics
NPI:1033251780
Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA MEDICO DEL NORTE P.S.C.
Entity Type:Organization
Organization Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA MEDICO DEL NORTE P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:RIVERA FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-7202
Mailing Address - Street 1:PMB 451
Mailing Address - Street 2:#267 CALLE SIERRA MORENA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-884-7202
Mailing Address - Fax:787-854-7768
Practice Address - Street 1:MANATI PROFESIONAL PLAZA
Practice Address - Street 2:SUITE 103
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-7202
Practice Address - Fax:787-854-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
PR8631261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR582026315OtherMEDICAL CARD SYSTEM
PR582026315OtherMCS CLASSICARE
PR600926OtherMEDICARE Y MUCHO MAS