Provider Demographics
NPI:1942615190
Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA DEL TURABO, LLC
Entity Type:Organization
Organization Name:INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA DEL TURABO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-258-7320
Mailing Address - Street 1:PO BOX 4961
Mailing Address - Street 2:PMB 331 S 1
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-258-7320
Mailing Address - Fax:787-258-5858
Practice Address - Street 1:50 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:205 QUADRANGLE MEDICAL CENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3975
Practice Address - Country:US
Practice Address - Phone:787-258-7320
Practice Address - Fax:787-258-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9601261QH0100X, 261QI0500X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1659398949OtherNPI
PR1659398949OtherNPI