Provider Demographics
NPI:1356589642
Name:UNIVERSAL ADVANCE GROUP, INC
Entity type:Organization
Organization Name:UNIVERSAL ADVANCE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELADIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-447-0941
Mailing Address - Street 1:12973 SW 112 ST
Mailing Address - Street 2:SUITE 336
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:786-447-0941
Mailing Address - Fax:305-428-9564
Practice Address - Street 1:12973 SW 112 ST
Practice Address - Street 2:SUITE 336
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:786-447-0941
Practice Address - Fax:305-428-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center