Provider Demographics
NPI:1952843179
Name:ADVANTAGE PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:ADVANTAGE PHYSICIAN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-625-2500
Mailing Address - Street 1:1551 CALLE ALDA
Mailing Address - Street 2:URB CARIBE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-625-2500
Mailing Address - Fax:787-625-0429
Practice Address - Street 1:1551 CALLE ALDA
Practice Address - Street 2:URB CARIBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-625-2500
Practice Address - Fax:787-625-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization