MEDICARE: NEUROLOGY & EPILEPSY, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	17907	PR

General Provider Information

NPI Number	:	1245789148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY & EPILEPSY, PSC

Provider Business Mailing Address
First Line	:	DA3 CALLE HASTINGS
Second Line	:	GARDEN HILLS NORTE
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2128
Country	:	US
Telephone Number	:	787-653-5060
Fax Number	:	787-653-9880

Provider Business Practice Location Address
First Line	:	30 CALLE PADIAL
Second Line	:	SUITE 120
City	:	CAGUAS
State	:	PR
Zip	:	00725-3807
Country	:	US
Telephone Number	:	787-653-5060
Fax Number	:	787-653-9880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KATHERINE M PADILLA RODRIGUEZ
Credential	:	MD
Telephone Number	:	787-653-5060

Provider Enumeration Date	:	10/03/2016
Last Update Date	:	10/03/2016

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