Provider Demographics
NPI:1043603889
Name:BAYAMON ONCOLOGY MEDICAL CSP
Entity Type:Organization
Organization Name:BAYAMON ONCOLOGY MEDICAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-4740
Mailing Address - Street 1:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5310
Mailing Address - Country:US
Mailing Address - Phone:787-269-4740
Mailing Address - Fax:787-269-4670
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INST. SAN PABLO SUITE 509
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-269-4740
Practice Address - Fax:787-269-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7336261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology