Healthcare Provider Details

I. General information

NPI: 1437540648
Provider Name (Legal Business Name): ADVANCE HEALTHCARE ALLIANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 CARR. 2 TORRE A SUITE 1001 METRO MEDICAL CENTER
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 127
BAYAMON PR
00960-0127
US

V. Phone/Fax

Practice location:
  • Phone: 787-966-7575
  • Fax: 787-966-7577
Mailing address:
  • Phone: 787-966-7575
  • Fax: 787-966-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LOURDES M RIVERA
Title or Position: PRESIDENT
Credential:
Phone: 787-966-7575