Healthcare Provider Details

I. General information

NPI: 1932545225
Provider Name (Legal Business Name): ADVANCED SURGICAL CENTER PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 AVE PINERO
SAN JUAN PR
00927
US

IV. Provider business mailing address

291 AVE PINERO
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-430-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number14372
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number14372
License Number StatePR

VIII. Authorized Official

Name: DR. LINKA MATOS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 787-430-7246