Provider Demographics
NPI:1194560631
Name:SPR PEDIATRIC & AYA HEMATOLOGY-ONCOLOGY PARTNERS LLC
Entity type:Organization
Organization Name:SPR PEDIATRIC & AYA HEMATOLOGY-ONCOLOGY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PABON-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-248-6575
Mailing Address - Street 1:252 CALLE SAN JORGE
Mailing Address - Street 2:OFICINA 504
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3239
Mailing Address - Country:US
Mailing Address - Phone:787-728-1575
Mailing Address - Fax:
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:OFICINA 504
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3239
Practice Address - Country:US
Practice Address - Phone:787-728-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty