Provider Demographics
NPI:1437111051
Name:ADVANCE MEDICAL TECHNOLOGY
Entity Type:Organization
Organization Name:ADVANCE MEDICAL TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHINEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-982-2192
Mailing Address - Street 1:P.O. BOX 11023
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2123
Mailing Address - Country:US
Mailing Address - Phone:787-982-2192
Mailing Address - Fax:787-982-2197
Practice Address - Street 1:1504 AVE. FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-982-2192
Practice Address - Fax:787-982-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1148700001Medicare ID - Type Unspecified