Healthcare Provider Details

I. General information

NPI: 1033251780
Provider Name (Legal Business Name): INSTITUTO DE HEMATOLOGIA Y ONCOLOGIA MEDICO DEL NORTE P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI PROFESIONAL PLAZA SUITE 103
MANATI PR
00674
US

IV. Provider business mailing address

PMB 451 #267 CALLE SIERRA MORENA
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-7202
  • Fax: 787-854-7768
Mailing address:
  • Phone: 787-884-7202
  • Fax: 787-854-7768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number8631
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier582026315
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMEDICAL CARD SYSTEM
# 2
Identifier582026315
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMCS CLASSICARE
# 3
Identifier600926
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMEDICARE Y MUCHO MAS

VIII. Authorized Official

Name: MS. MAYRA IVETTE RIVERA FIGUEROA
Title or Position: MEDICO
Credential: M.D.
Phone: 787-884-7202