Basic Information
| Provider Information | |||||||||
| NPI: | 1265990048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCE MEDICAL & ADMINISTRATIVE SUPPORT CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 SALUD | ||||||||
| Address2: | CONDOMINIO EL SENORIAL PLAZA SUITE 413 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00731 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1326 SALUD | ||||||||
| Address2: | CONDOMINIO EL SENORIAL PLAZA SUITE 413 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878411949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 03/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 7876052729 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | Y | Managed Care Organizations | Point of Service |
No ID Information.