Provider Demographics
NPI:1821458704
Name:SICK BLOOD MED SERV CSP
Entity Type:Organization
Organization Name:SICK BLOOD MED SERV CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOLIVAN ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-771-7933
Mailing Address - Street 1:369 CALLE DE DIEGO STE 603-604
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3003
Mailing Address - Country:US
Mailing Address - Phone:787-753-6022
Mailing Address - Fax:787-753-6066
Practice Address - Street 1:369 CALLE DE DIEGO STE 603-604
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-753-6022
Practice Address - Fax:787-753-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17625207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17625OtherLIC