Healthcare Provider Details

I. General information

NPI: 1467382739
Provider Name (Legal Business Name): MEDICINA PRIMARIA AVANZADA PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GO7 AVE ROBERTO SANCHEZ VILELLA
CAROLINA PR
00982-2678
US

IV. Provider business mailing address

202 BLVD MEDIA LUNA
CAROLINA PR
00987-5086
US

V. Phone/Fax

Practice location:
  • Phone: 787-776-3145
  • Fax:
Mailing address:
  • Phone: 787-633-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PABLO A. FONTANET
Title or Position: PRESIDENT
Credential: MD
Phone: 787-633-8153