MEDICARE: ADVANCE WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1467026468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE WELLNESS CENTER

Provider Business Mailing Address
First Line	:	CARR. 844 #1777 LITHEDA HEIGHTS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-748-9955
Fax Number	:	787-946-8712

Provider Business Practice Location Address
First Line	:	CARR. 844 #1777 LITHEDA HEIGHTS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-748-9955
Fax Number	:	787-946-8712

Authorized Official
Title or Position	:	CEO
Name	:	DR. ORVIL FELIX MARTINEZ
Credential	:	MD
Telephone Number	:	787-748-9955

Provider Enumeration Date	:	05/14/2021
Last Update Date	:	05/14/2021

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