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General NPI Number Information
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NPI Number | 1871226415
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Entity Type | Organization
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Legal Business Name | ADVANCED RETINA LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | CALLE UNION #91 ESQ CALLE SOL
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City | PONCE
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State | PR
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Zip | 00730
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Country | US
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Telephone | 787-848-5353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7432
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City | PONCE
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State | PR
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Zip | 00732-7432
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Country | US
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Telephone | 787-432-4849
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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. JAN CARLOS ORTIZ ROSARIO
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Credential | MD
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Telephone | 787-432-4849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number |
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License Number State |
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