Provider Demographics
NPI:1093985871
Name:DOCTORS CENTER HEMATOLOGY & ONCOLOGY GROUP BAYAMON PSC
Entity Type:Organization
Organization Name:DOCTORS CENTER HEMATOLOGY & ONCOLOGY GROUP BAYAMON PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-621-3400
Mailing Address - Street 1:1995 CARR 2
Mailing Address - Street 2:SUITE 2701
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2701
Mailing Address - Country:US
Mailing Address - Phone:787-621-3400
Mailing Address - Fax:787-621-3401
Practice Address - Street 1:KM 12 3 CARR 2
Practice Address - Street 2:SUITE 2701 URB HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-621-3400
Practice Address - Fax:787-621-3401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS CENTER HEMATOLOGY & ONCOLOGY GROUP BAYAMON PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10800261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085513Medicare PIN