Provider Demographics
NPI:1407032808
Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA MEDICA DEL NORTE
Entity Type:Organization
Organization Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA MEDICA DEL NORTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-817-4973
Mailing Address - Street 1:53 CALLE ANDRES GARCIA
Mailing Address - Street 2:URB. GARCIA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4335
Mailing Address - Country:US
Mailing Address - Phone:787-817-4973
Mailing Address - Fax:
Practice Address - Street 1:53 CALLE ANDRES GARCIA
Practice Address - Street 2:URB. GARCIA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4335
Practice Address - Country:US
Practice Address - Phone:787-817-4973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10600261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology