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General NPI Number Information
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NPI Number | 1902340177
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Entity Type | Organization
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Legal Business Name | WESTERN HEMATOLOGY ONCOLOGY GROUP P.S.C
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 12/07/2016
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Provider Practice Location Address
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Address Line | CALLE HERNAN ALVAREZ PLAZA METROPOLITANA SUITE 206
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-892-2540
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Fax | 787-892-2540
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Provider Business Mailing Address
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Address Line | PO BOX 5075 PMB 205
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-892-2540
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Fax | 787-892-2540
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. WANDA CASIANO
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Credential | M.D.
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Telephone | 787-892-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 11839
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License Number State | PR
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