MEDICARE: ADVANCED NEUROLOGY CENTER OF PR

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	2084N0400X	Neurology Physician	17359	PR

General Provider Information

NPI Number	:	1508155433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED NEUROLOGY CENTER OF PR

Provider Business Mailing Address
First Line	:	2 CALLE MUNOZ RIVERA
Second Line	:	SUITE 211
City	:	CAGUAS
State	:	PR
Zip	:	00725-2603
Country	:	US
Telephone Number	:	787-905-7500
Fax Number	:	787-905-7545

Provider Business Practice Location Address
First Line	:	2 CALLE MUNOZ RIVERA
Second Line	:	SUITE 211
City	:	CAGUAS
State	:	PR
Zip	:	00725-2603
Country	:	US
Telephone Number	:	787-905-7500
Fax Number	:	787-905-7545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LOURDES M BENES
Credential	:	M.D.
Telephone Number	:	787-905-7500

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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