Provider Demographics
NPI:1083840136
Name:ADVANCE ADULT MEDICAL CLINIC
Entity Type:Organization
Organization Name:ADVANCE ADULT MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAMPOS SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:787-731-4949
Mailing Address - Street 1:864 C/ ASHFORD APT. 610 FLANBOYAN APT.
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-731-4949
Mailing Address - Fax:787-731-4949
Practice Address - Street 1:PLAZA GUAYNABO SHOPPING MALL
Practice Address - Street 2:ALTOS CARIBBEAN CINEMAS, SUITE 201
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-731-4949
Practice Address - Fax:787-731-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center