Healthcare Provider Details

I. General information

NPI: 1518652866
Provider Name (Legal Business Name): NAPLES NEURO CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 PINE RIDGE RD STE 19
NAPLES FL
34109-2110
US

IV. Provider business mailing address

2338 IMMOKALEE RD STE 335
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 239-944-5054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDISON VALLE-GILER
Title or Position: OWNER
Credential: MD
Phone: 239-919-4342