Provider Demographics
NPI:1467879056
Name:FERSAL HEMA-ONCO PSC
Entity Type:Organization
Organization Name:FERSAL HEMA-ONCO PSC
Other - Org Name:GRUPO DE HEMATOLOGIA Y ONCOLOGIA DEL ESTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERNANDEZ CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-383-5859
Mailing Address - Street 1:50 CALLE SAN JOSE
Mailing Address - Street 2:COND SAN FRANCISCO JAVIER APT 502
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4738
Mailing Address - Country:US
Mailing Address - Phone:787-383-5859
Mailing Address - Fax:787-701-0067
Practice Address - Street 1:3 CALLE FONT MARTELO E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3617
Practice Address - Country:US
Practice Address - Phone:787-656-2424
Practice Address - Fax:787-701-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6436OtherREGISTRO PR