Provider Demographics
NPI:1205127032
Name:ADVANCED ENDOSCOPY CENTER PSC
Entity type:Organization
Organization Name:ADVANCED ENDOSCOPY CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYMUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-259-8212
Mailing Address - Street 1:EDIFICIO PARRA SUITE 806
Mailing Address - Street 2:2225 PONCE BY PASS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-259-8212
Mailing Address - Fax:787-848-7979
Practice Address - Street 1:2225 PONCE BYP STE 806
Practice Address - Street 2:2225 PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1379
Practice Address - Country:US
Practice Address - Phone:787-259-8212
Practice Address - Fax:787-848-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0800X
PR22261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4953OtherNUM REGISTRO