Provider Demographics
NPI:1184907479
Name:ADVANCE ONCOLOGY GROUP
Entity type:Organization
Organization Name:ADVANCE ONCOLOGY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAULO MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-891-0027
Mailing Address - Street 1:GALLERY PLAZA 103
Mailing Address - Street 2:AVE JOSE DE DIEGO APT 2107
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-891-0027
Mailing Address - Fax:787-997-2222
Practice Address - Street 1:150 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:REPARTO LOPEZ
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5714
Practice Address - Country:US
Practice Address - Phone:787-891-0027
Practice Address - Fax:787-997-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X, 207RX0202X, 261QX0200X
PR16891261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16861OtherLICENSE