Provider Demographics
NPI:1093776130
Name:CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL ESTE CSP
Entity Type:Organization
Organization Name:CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL ESTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:NILSA
Authorized Official - Last Name:CORTES MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-801-0000
Mailing Address - Street 1:PO BOX 4186
Mailing Address - Street 2:PUERTO REAL
Mailing Address - City:PUERTO REAL
Mailing Address - State:PR
Mailing Address - Zip Code:00740-4186
Mailing Address - Country:US
Mailing Address - Phone:787-801-0000
Mailing Address - Fax:787-860-7105
Practice Address - Street 1:410 AVE GENERAL VALERO
Practice Address - Street 2:TORRE MEDICA HIMA, SUITE 303
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3949
Practice Address - Country:US
Practice Address - Phone:787-801-0000
Practice Address - Fax:787-860-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12895261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083730Medicare PIN