Provider Demographics
NPI:1699812784
Name:CENTER FOR ADVANCED SURGERY
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-724-0278
Mailing Address - Street 1:PARQUE DE VILLA CAPARRA
Mailing Address - Street 2:#21 CALLE ZUANIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-354-5146
Mailing Address - Fax:787-724-0283
Practice Address - Street 1:ASHFORD MEDICAL CENTER
Practice Address - Street 2:WASHINGTON #29 SUITE 504
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-724-0278
Practice Address - Fax:787-724-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13327208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty