Provider Demographics
NPI:1689895435
Name:P R HEMATOLOGY ONCOLOGY GROUP INC
Entity Type:Organization
Organization Name:P R HEMATOLOGY ONCOLOGY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-780-2830
Mailing Address - Street 1:100 PASEO SAN PABLO
Mailing Address - Street 2:ARTURO CADILLA SUITE 511
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7019
Mailing Address - Country:US
Mailing Address - Phone:787-780-2830
Mailing Address - Fax:787-786-8281
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:ARTURO CADILLA SUITE 511
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-780-2830
Practice Address - Fax:787-786-8281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P R HEMATOLOGY ONCOLOGY GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12565OtherSSS