Provider Demographics
NPI:1407955941
Name:ADVANCE OB/GYN, P.S.C.
Entity Type:Organization
Organization Name:ADVANCE OB/GYN, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-727-4333
Mailing Address - Street 1:PO BOX 19869
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1869
Mailing Address - Country:US
Mailing Address - Phone:787-727-4333
Mailing Address - Fax:787-268-7077
Practice Address - Street 1:PAVIA MEDICAL PLAZA 611
Practice Address - Street 2:M PAVIA FERNANDEZ SUITE 205
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-743-3333
Practice Address - Fax:787-268-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty