Provider Demographics
NPI:1326160227
Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA DEL TURABO
Entity Type:Organization
Organization Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA DEL TURABO
Other - Org Name:EVELYN FONSECA, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-258-5858
Mailing Address - Street 1:PMB 331
Mailing Address - Street 2:PO BOX 4961
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4961
Mailing Address - Country:US
Mailing Address - Phone:787-258-5858
Mailing Address - Fax:787-258-5858
Practice Address - Street 1:SAN JUAN BAUTISTA MEDICAL CENTER
Practice Address - Street 2:RD. 172, URB. TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-258-5858
Practice Address - Fax:787-258-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9601261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82480OtherTRIPLE-S
PR82480OtherTRIPLE-S
PRE-91208Medicare UPIN