MEDICARE: HATO REY HEMATOLOGY ONCOLOGY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1174551154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HATO REY HEMATOLOGY ONCOLOGY GROUP

Provider Business Mailing Address
First Line	:	PO BOX 11965
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-1965
Country	:	US
Telephone Number	:	787-758-6225
Fax Number	:	787-756-7853

Provider Business Practice Location Address
First Line	:	735 PONCE DE LEON SUITE 701
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-5025
Country	:	US
Telephone Number	:	787-758-6225
Fax Number	:	787-756-7853

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RAFAEL RIVERA
Credential	:	MHSA
Telephone Number	:	787-758-6225

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/22/2020

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