Healthcare Provider Details

I. General information

NPI: 1760301170
Provider Name (Legal Business Name): MALIGNANT HEME ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON
HATO REY PR
00917-5032
US

IV. Provider business mailing address

405 AVE ESMERALDA STE 2
GUAYNABO PR
00969-4466
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DOEL MARRERO LEON
Title or Position: PRESIDENT
Credential: MD
Phone: 787-247-2880