Provider Demographics
NPI:1346950672
Name:PONCE ADVANCE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:PONCE ADVANCE MEDICAL GROUP, LLC
Other - Org Name:PONCE ADVANCE MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-843-3089
Mailing Address - Street 1:PMB 282
Mailing Address - Street 2:1575 MUNOZ RIVERA AVENUE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-813-2325
Mailing Address - Fax:787-841-3908
Practice Address - Street 1:CALLE FERROCARRIL MUNOZ RIVERA AVENUE
Practice Address - Street 2:LOCAL #4
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0071
Practice Address - Country:US
Practice Address - Phone:787-813-2325
Practice Address - Fax:787-841-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory