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General NPI Number Information
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NPI Number | 1720312895
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERNAL MEDICINE & CARDIOVASCULAR CENTER OF P.R. P.S.C
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 735 AVE PONCE DE LEON TORRE MEDICA AUXILIO MUTUO SUITE 415
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City | SAN JUAN
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State | PR
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Zip | 00917-5022
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Country | US
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Telephone | 787-763-9813
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 192382
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City | SAN JUAN
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State | PR
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Zip | 00919-2382
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Country | US
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Telephone | 787-763-9813
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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. JOSUE A PABON
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Credential | M.D.
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Telephone | 787-763-9813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 8158
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License Number State | PR
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