Provider Demographics
NPI:1841594785
Name:CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL SUR, CSP
Entity Type:Organization
Organization Name:CENTRO DE HEMATOLOGIA Y ONCOLOGIA DEL SUR, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATOS-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-479-2608
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-0937
Mailing Address - Country:US
Mailing Address - Phone:787-479-2608
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 153 KM 7.3 PLAZA SANTA ISABEL
Practice Address - Street 2:SUITE 15
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00797-0000
Practice Address - Country:US
Practice Address - Phone:787-845-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16901261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDL451AMedicare PIN