MEDICARE: ADVANCED PROFESSIONAL OB/GYN, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	13838	PR
2	207V00000X	Obstetrics & Gynecology Physician	13460	PR

General Provider Information

NPI Number	:	1760486575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PROFESSIONAL OB/GYN, PSC

Provider Business Mailing Address
First Line	:	PMB 493
Second Line	:	PO BOX 70344
City	:	SAN JUAN
State	:	PR
Zip	:	00936-8344
Country	:	US
Telephone Number	:	787-751-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	EL MONTE MALL SHOPPING CENTER SUITE 3225
Second Line	:	652 AVE MUNOZ-RIVERA
City	:	SAN JUAN
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:	787-751-6210
Fax Number	:

Authorized Official
Title or Position	:	SR
Name	:	ROBERTO F LOPEZ-ROSARIO
Credential	:	M.D.
Telephone Number	:	787-751-6210

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/22/2020

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