Provider Demographics
NPI:1942203039
Name:HATO REY HEMATOLOGY ONCOLOGY GROUP
Entity Type:Organization
Organization Name:HATO REY HEMATOLOGY ONCOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-763-1788
Mailing Address - Street 1:PO BOX 11965
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1965
Mailing Address - Country:US
Mailing Address - Phone:787-763-1788
Mailing Address - Fax:787-756-7853
Practice Address - Street 1:735 AVE PONCE DE LEON
Practice Address - Street 2:STE 408
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5025
Practice Address - Country:US
Practice Address - Phone:787-763-1788
Practice Address - Fax:787-756-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6085207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29906Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER