Provider Demographics
NPI:1407314891
Name:ADVANCED PROVIDERS SERVICES LLC
Entity Type:Organization
Organization Name:ADVANCED PROVIDERS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-503-0481
Mailing Address - Street 1:3431 PERSHING DR STE A2
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2701
Mailing Address - Country:US
Mailing Address - Phone:915-503-0481
Mailing Address - Fax:
Practice Address - Street 1:3431 PERSHING DR STE A2
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2701
Practice Address - Country:US
Practice Address - Phone:915-503-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty