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General NPI Number Information
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NPI Number | 1306371240
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Entity Type | Organization
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Legal Business Name | ADVANCE PROSTHETICS
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 200 C MARGINAL SUITE 125
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City | CANOVANAS
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State | PR
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Zip | 00729-4312
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Country | US
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Telephone | 939-539-8513
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Fax | 787-539-8513
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Provider Business Mailing Address
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Address Line | PO BOX 1702
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City | CANOVANAS
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State | PR
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Zip | 00729-1702
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Country | US
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Telephone | 939-539-8513
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Fax | 939-539-8513
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAFEL E TORRES
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Credential |
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Telephone | 787-323-3435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 19141
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License Number State | PR
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