Provider Demographics
NPI:1124225974
Name:ADVANCER LOCAL DEVELOPMENT
Entity Type:Organization
Organization Name:ADVANCER LOCAL DEVELOPMENT
Other - Org Name:BASIC MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:CELENIA
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-374-2001
Mailing Address - Street 1:PO BOX 191060
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1060
Mailing Address - Country:US
Mailing Address - Phone:787-756-8612
Mailing Address - Fax:787-281-7809
Practice Address - Street 1:402 MUNOZ RIVERA AVENUE
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919-1060
Practice Address - Country:US
Practice Address - Phone:787-756-8612
Practice Address - Fax:787-281-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization