Provider Demographics
NPI:1407640477
Name:ADVANCED GLAUCOMA CARE
Entity type:Organization
Organization Name:ADVANCED GLAUCOMA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTIAGO DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:787-728-2318
Mailing Address - Street 1:611 CALLE PAVIA STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2244
Mailing Address - Country:US
Mailing Address - Phone:787-728-2318
Mailing Address - Fax:
Practice Address - Street 1:611 CALLE PAVIA STE 210
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2244
Practice Address - Country:US
Practice Address - Phone:787-728-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty