Provider Demographics
NPI:1144316803
Name:ADVANCED OB-GYN PSC
Entity type:Organization
Organization Name:ADVANCED OB-GYN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ-TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-397-2290
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1775
Mailing Address - Country:US
Mailing Address - Phone:787-738-9938
Mailing Address - Fax:787-738-9939
Practice Address - Street 1:CARR 14 INTERIOR KM 0.3
Practice Address - Street 2:CENTRO MEDICO MENONITA EDIFICIO PROFESIONAL SUITE 311
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-9938
Practice Address - Fax:787-738-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13452207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHP958AMedicare PIN