Provider Demographics
NPI:1023736907
Name:HEMATOLOGY ONCOLOGY CARE GROUP LLC
Entity type:Organization
Organization Name:HEMATOLOGY ONCOLOGY CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYA QUINQUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-410-2877
Mailing Address - Street 1:735 AVE PONCE DE LEON STE 416
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5026
Mailing Address - Country:US
Mailing Address - Phone:787-410-2877
Mailing Address - Fax:
Practice Address - Street 1:735 AVE PONCE DE LEON STE 416
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5026
Practice Address - Country:US
Practice Address - Phone:787-410-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty