Healthcare Provider Details

I. General information

NPI: 1891031357
Provider Name (Legal Business Name): ADVANCE IMPLANT, TISSUE AND CELL TECHNOLOGIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PUERTO GALEXEDA CALLE 2 # E3
PENUELAS PR
00624
US

IV. Provider business mailing address

PO BOX 35025
PONCE PR
00734-5025
US

V. Phone/Fax

Practice location:
  • Phone: 787-464-4969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL GARCIA-CORREA
Title or Position: PRESIDENT
Credential:
Phone: 787-464-4969