Provider Demographics
NPI:1700165685
Name:ADVANCED RENAL VASCULAR CENTER P.S.C
Entity Type:Organization
Organization Name:ADVANCED RENAL VASCULAR CENTER P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:HURTADO-SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-677-7885
Mailing Address - Street 1:357 AVE HOSTOS STE 203
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1535
Mailing Address - Country:US
Mailing Address - Phone:787-806-2200
Mailing Address - Fax:787-806-2239
Practice Address - Street 1:357 AVE HOSTOS STE 203
Practice Address - Street 2:OFFICE PARK II
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1535
Practice Address - Country:US
Practice Address - Phone:787-806-2200
Practice Address - Fax:787-806-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16554207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty