1306190707 NPI number — ADVANCEPRIMARYCARE MEDICINEPSC

Table of content: (NPI 1306190707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306190707 NPI number — ADVANCEPRIMARYCARE MEDICINEPSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCEPRIMARYCARE MEDICINEPSC
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:
1306190707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BARRIO JUNCAL CARRETERA 111 KM 30.3 SECTOR PUJOLS
Provider Second Line Business Mailing Address:
HC03 BOX 35468
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-7565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-969-2479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BARRIO GUATEMALA
Provider Second Line Business Practice Location Address:
CARRETERA 111 KM 16.9
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-7565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-428-2299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
IVAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
939-969-2479

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  17154 , 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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