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General NPI Number Information
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NPI Number | 1306190707
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Entity Type | Organization
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Legal Business Name | ADVANCEPRIMARYCARE MEDICINEPSC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | BARRIO GUATEMALA CARRETERA 111 KM 16.9
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-7565
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Country | US
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Telephone | 787-428-2299
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Fax |
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Provider Business Mailing Address
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Address Line | BARRIO JUNCAL CARRETERA 111 KM 30.3 SECTOR PUJOLS HC03 BOX 35468
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-7565
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Country | US
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Telephone | 939-969-2479
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE IVAN MENDEZ
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Credential | MD
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Telephone | 939-969-2479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 17154
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License Number State | PR
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