Provider Demographics
NPI:1659649051
Name:AVANCINO MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:AVANCINO MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-847-2441
Mailing Address - Street 1:17 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2228
Mailing Address - Country:US
Mailing Address - Phone:787-847-2441
Mailing Address - Fax:787-847-2441
Practice Address - Street 1:17 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2228
Practice Address - Country:US
Practice Address - Phone:787-847-2441
Practice Address - Fax:787-847-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR010114261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service