1144316803 NPI number — ADVANCED OB-GYN PSC

Table of content: (NPI 1144316803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144316803 NPI number — ADVANCED OB-GYN PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED OB-GYN PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144316803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIDRA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00739-1775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-738-9938
Provider Business Mailing Address Fax Number:
787-738-9939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 14 INTERIOR KM 0.3
Provider Second Line Business Practice Location Address:
CENTRO MEDICO MENONITA EDIFICIO PROFESIONAL SUITE 311
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-738-9938
Provider Business Practice Location Address Fax Number:
787-738-9939
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ-TORRES
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-397-2290

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  13452 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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