Provider Demographics
NPI:1134409212
Name:ADVANCED RENAL GROUP
Entity type:Organization
Organization Name:ADVANCED RENAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER ORGANIZATION
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-366-7961
Mailing Address - Street 1:375 CALLE SAN MARTIN
Mailing Address - Street 2:LIRIOS CALA 2
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-366-7961
Mailing Address - Fax:
Practice Address - Street 1:375 CALLE SAN MARTIN
Practice Address - Street 2:LIRIOS CALA 2
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-8506
Practice Address - Country:US
Practice Address - Phone:787-366-7961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17630207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty