MEDICARE: MEDICINA PRIMARIA AVANZADA PSC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1467382739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINA PRIMARIA AVANZADA PSC

Provider Business Mailing Address
First Line	:	202 BLVD MEDIA LUNA
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00987-5086
Country	:	US
Telephone Number	:	787-633-8153
Fax Number	:

Provider Business Practice Location Address
First Line	:	GO7 AVE ROBERTO SANCHEZ VILELLA
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00982-2678
Country	:	US
Telephone Number	:	787-776-3145
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PABLO A. FONTANET
Credential	:	MD
Telephone Number	:	787-633-8153

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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