Provider Demographics
NPI:1457074999
Name:ADVANCE GYNECOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:ADVANCE GYNECOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUADALUPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-850-4820
Mailing Address - Street 1:264 CALLE LA TORRECILLA
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-4088
Mailing Address - Country:US
Mailing Address - Phone:787-530-6219
Mailing Address - Fax:
Practice Address - Street 1:51 CALLE FLOR GERENA S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4207
Practice Address - Country:US
Practice Address - Phone:787-850-4820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty