=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235800327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERNANDEZ-PONS HEMATOLOGY ONCOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2021
-----------------------------------------------------
Last Update Date | 07/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1418 CALLE AMERICO SALAS
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00909-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-523-6944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 369 CALLE SAN CLAUDIO UNIT 261146
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-0645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-206-1071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. EDUARDO JOEL HERNANDEZ-PONS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-206-1061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------