Healthcare Provider Details

I. General information

NPI: 1164344370
Provider Name (Legal Business Name): MEDPLUS ADVANCE CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 FOREST HILL BLVD STE 101
WEST PALM BEACH FL
33406-5964
US

IV. Provider business mailing address

2669 FOREST HILL BLVD STE 101
WEST PALM BEACH FL
33406-5964
US

V. Phone/Fax

Practice location:
  • Phone: 561-970-5171
  • Fax: 561-421-5947
Mailing address:
  • Phone: 561-970-5171
  • Fax: 561-421-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LIDICE LEYVA
Title or Position: CEO
Credential: APRN
Phone: 561-248-9446