Healthcare Provider Details

I. General information

NPI: 1578802658
Provider Name (Legal Business Name): ADVANCED NEUROLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LOVEJOY CIR
CASTLE ROCK CO
80104-9829
US

IV. Provider business mailing address

PO BOX 237
CASTLE ROCK CO
80104-0237
US

V. Phone/Fax

Practice location:
  • Phone: 407-255-8488
  • Fax: 407-255-8487
Mailing address:
  • Phone: 407-255-8488
  • Fax: 407-255-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE L CARRAU LEBRON
Title or Position: SOLE MEMBER
Credential: MD
Phone: 504-400-2061