1508816091 NPI number — GRUPO NEUROLOGIA AVANZADA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508816091 NPI number — GRUPO NEUROLOGIA AVANZADA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO NEUROLOGIA AVANZADA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508816091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
# 2 MUNOZ RIVERA STREET
Provider Second Line Business Mailing Address:
PROFESSIONAL CENTER COND.. SUITE 213
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-6065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-744-3490
Provider Business Mailing Address Fax Number:
787-745-0035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
# 2 MUNOZ RIVERA STREET
Provider Second Line Business Practice Location Address:
SUITE 213 COND. PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-3490
Provider Business Practice Location Address Fax Number:
787-745-0035
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-744-3490

Provider Taxonomy Codes

  • Taxonomy code: 170100000X , with the licence number:  3353 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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