Provider Demographics
NPI:1760486575
Name:ADVANCED PROFESSIONAL OB/GYN, PSC
Entity Type:Organization
Organization Name:ADVANCED PROFESSIONAL OB/GYN, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOPEZ-ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-751-6210
Mailing Address - Street 1:PMB 493
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-751-6210
Mailing Address - Fax:
Practice Address - Street 1:EL MONTE MALL SHOPPING CENTER SUITE 3225
Practice Address - Street 2:652 AVE MUNOZ-RIVERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-6210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13460207V00000X
PR13838207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084932Medicare ID - Type Unspecified