Provider Demographics
NPI:1740313782
Name:ADVANCED HEMATOLOGY AND ONCOLOGY OF PUERTO RICO
Entity type:Organization
Organization Name:ADVANCED HEMATOLOGY AND ONCOLOGY OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-744-8686
Mailing Address - Street 1:LUIS MUNOZ MARIN AVE
Mailing Address - Street 2:HIMA SAN PABLO SUITE 907
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-744-8686
Mailing Address - Fax:787-258-1125
Practice Address - Street 1:AVE LUIS MUNOZ MARIN
Practice Address - Street 2:HIMA SAN PABLO SUITE 907
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-8686
Practice Address - Fax:787-258-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12477207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90436Medicare ID - Type Unspecified