1144533746 NPI number — PUERTO RICO NEUROLOGICAL SPINE SURGERY

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 1144533746 NPI number — PUERTO RICO NEUROLOGICAL SPINE SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUERTO RICO NEUROLOGICAL SPINE SURGERY
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:
6
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:
1144533746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 QUINTAS LAS AMERICAS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-7910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-522-5454
Provider Business Mailing Address Fax Number:
787-522-5473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1845 CARR 2 STE 702
Provider Second Line Business Practice Location Address:
BAYAMON MEDICAL BUILDING
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-522-5454
Provider Business Practice Location Address Fax Number:
787-522-5473
Provider Enumeration Date:
07/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CARDONA DURAN
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
FRANCISCO
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
787-723-5553

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  13634 , 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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