Healthcare Provider Details

I. General information

NPI: 1467026468
Provider Name (Legal Business Name): ADVANCE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 844 #1777 LITHEDA HEIGHTS
SAN JUAN PR
00926
US

IV. Provider business mailing address

CARR. 844 #1777 LITHEDA HEIGHTS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-748-9955
  • Fax: 787-946-8712
Mailing address:
  • Phone: 787-748-9955
  • Fax: 787-946-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ORVIL FELIX MARTINEZ
Title or Position: CEO
Credential: MD
Phone: 787-748-9955