Basic Information
| Provider Information | |||||||||
| NPI: | 1003893272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADVINCULA | ||||||||
| FirstName: | RIZALITO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 PINE ST | ||||||||
| Address2: | BUCKTAIL MEDICAL CENTER | ||||||||
| City: | RENOVO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177641618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709231000 | ||||||||
| FaxNumber: | 5709230835 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 PINE ST | ||||||||
| Address2: | BUCKTAIL MEDICAL CENTER | ||||||||
| City: | RENOVO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177641618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709231000 | ||||||||
| FaxNumber: | 5709230835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AD108434 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AD108434 | 01 | PA | LICENSE # | OTHER | MDD432445L | 01 | PA | LICENSE # | OTHER |