Provider Demographics
NPI:1801361167
Name:ADVANCED PRIMARY CARE SERVICES LLC
Entity type:Organization
Organization Name:ADVANCED PRIMARY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-998-7015
Mailing Address - Street 1:PMB 319 100 GRAND PASEOS BLVD
Mailing Address - Street 2:STE 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-998-7015
Mailing Address - Fax:787-998-7016
Practice Address - Street 1:CENTRO COMERCIAL PONCE DE LEON EDF A LOCAL 6
Practice Address - Street 2:AVE. ESMERALDA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-998-7015
Practice Address - Fax:787-998-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14312OtherMEDICAL LICENCE