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General NPI Number Information
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NPI Number | 1902364813
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Entity Type | Organization
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Legal Business Name | ADVANCE MEDICAL & ADMINISTRATIVE SUPPORT USA LLC
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Dates
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Enumeration Date | 03/10/2019
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Last Update Date | 03/10/2019
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Provider Practice Location Address
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Address Line | 5940 PELICAN BAY PLZ S APT 306
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City | GULFPORT
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State | FL
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Zip | 33707-3956
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Country | US
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Telephone | 787-605-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 5940 PELICAN BAY PLZ S APT 306
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City | GULFPORT
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State | FL
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Zip | 33707-3956
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Country | US
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Telephone | 787-605-2729
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. CARLOS RIVERA
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Credential |
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Telephone | 787-605-2729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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