1760486575 NPI number — ADVANCED PROFESSIONAL OB/GYN, PSC

Table of content: (NPI 1760486575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760486575 NPI number — ADVANCED PROFESSIONAL OB/GYN, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PROFESSIONAL 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:
1760486575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 493
Provider Second Line Business Mailing Address:
PO BOX 70344
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-8344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-751-6210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EL MONTE MALL SHOPPING CENTER SUITE 3225
Provider Second Line Business Practice Location Address:
652 AVE MUNOZ-RIVERA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-751-6210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ-ROSARIO
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
F
Authorized Official Title or Position:
SR
Authorized Official Telephone Number:
787-751-6210

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  13460 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 13838 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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