Healthcare Provider Details

I. General information

NPI: 1073483822
Provider Name (Legal Business Name): MEDICAL ADVANCE PHARMA GROUP CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10531 BLOOMINGDALE RIDGE DR STE D
RIVERVIEW FL
33578-5153
US

IV. Provider business mailing address

10531 BLOOMINGDALE RIDGE DR STE D
RIVERVIEW FL
33578-5153
US

V. Phone/Fax

Practice location:
  • Phone: 888-613-5393
  • Fax:
Mailing address:
  • Phone: 888-613-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALBERT DEC
Title or Position: DIRECTOR
Credential: DR
Phone: 888-613-5393