Basic Information
| Provider Information | |||||||||
| NPI: | 1366765117 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRICS AND HO BMT GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 CALLE CEDRO | ||||||||
| Address2: | SABANERA DEL RIO | ||||||||
| City: | GURABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007782763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876455663 | ||||||||
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| Practice Location | |||||||||
| Address1: | AVE DEGETAU | ||||||||
| Address2: | HIMA SAN PABLO HOSPITAL | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007255819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2010 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUERRA | ||||||||
| AuthorizedOfficialFirstName: | JHON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7876455663 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 15047 | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.