Healthcare Provider Details

I. General information

NPI: 1245394634
Provider Name (Legal Business Name): BNCNEUROIOM. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 SW 136TH PL
MIAMI FL
33184-1056
US

IV. Provider business mailing address

529 SW 136 PLACE
MIAMI FL
33184
US

V. Phone/Fax

Practice location:
  • Phone: 305-724-6990
  • Fax: 305-553-5186
Mailing address:
  • Phone: 305-724-6990
  • Fax: 305-553-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. GUILLERMO PINEIRO
Title or Position: PRESIDENT
Credential:
Phone: 305-724-6990