Provider Demographics
NPI:1578843652
Name:CENTRO HEMATOLOGICO Y ONCOLOGICO PRIMAVERA P.S.C.
Entity Type:Organization
Organization Name:CENTRO HEMATOLOGICO Y ONCOLOGICO PRIMAVERA P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-960-3314
Mailing Address - Street 1:500 CAMINO MIRAMONTES
Mailing Address - Street 2:URB SABANERA DEL RIO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5265
Mailing Address - Country:US
Mailing Address - Phone:787-960-3314
Mailing Address - Fax:
Practice Address - Street 1:172 STREET KM 1.0
Practice Address - Street 2:CENTRO DE SALUD FAMILIAR CIDRA
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3030
Practice Address - Country:US
Practice Address - Phone:787-714-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16706261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology