Healthcare Provider Details

I. General information

NPI: 1801361167
Provider Name (Legal Business Name): ADVANCED PRIMARY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO COMERCIAL PONCE DE LEON EDF A LOCAL 6 AVE. ESMERALDA
GUAYNABO PR
00969
US

IV. Provider business mailing address

PMB 319 100 GRAND PASEOS BLVD STE 112
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-998-7015
  • Fax: 787-998-7016
Mailing address:
  • Phone: 787-998-7015
  • Fax: 787-998-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IVAN PEREZ RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-998-7015