Healthcare Provider Details

I. General information

NPI: 1902212905
Provider Name (Legal Business Name): ADVANCE UROLOGY & LAPAROSCOPIC CTR PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO STE 710 TORRE MEDICA SAN LUCAS
PONCE PR
00716
US

IV. Provider business mailing address

609 AVE TITO CASTRO STE 102 PMB 363
PONCE PR
00716-0200
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-3333
  • Fax: 787-284-1722
Mailing address:
  • Phone: 787-284-3333
  • Fax: 787-284-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13510
License Number StatePR

VIII. Authorized Official

Name: DR. GILBERTO RUIZ DEYA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-284-3333