Healthcare Provider Details

I. General information

NPI: 1134409212
Provider Name (Legal Business Name): ADVANCED RENAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 CALLE SAN MARTIN LIRIOS CALA 2
JUNCOS PR
00777-8506
US

IV. Provider business mailing address

375 CALLE SAN MARTIN LIRIOS CALA 2
JUNCOS PR
00777
US

V. Phone/Fax

Practice location:
  • Phone: 787-366-7961
  • Fax:
Mailing address:
  • Phone: 787-366-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17630
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RICARDO M CALDERON
Title or Position: TREASURER ORGANIZATION
Credential: MD
Phone: 787-366-7961