Provider Demographics
NPI:1801030242
Name:CENTRO AVANZADO MEDICINA GERIATRICA
Entity Type:Organization
Organization Name:CENTRO AVANZADO MEDICINA GERIATRICA
Other - Org Name:CAMG
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTORA DE OPERACIONES FISCALES
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-813-0080
Mailing Address - Street 1:PO BOX 336149
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6149
Mailing Address - Country:US
Mailing Address - Phone:787-813-0080
Mailing Address - Fax:787-840-8874
Practice Address - Street 1:CALLE FERROCARRIL ESQ. TORRES
Practice Address - Street 2:# 607
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-6149
Practice Address - Country:US
Practice Address - Phone:787-813-0080
Practice Address - Fax:787-840-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66623Medicare UPIN