Healthcare Provider Details

I. General information

NPI: 1518362714
Provider Name (Legal Business Name): MS NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AGUADILLA MALL STE 201
AGUADILLA PR
00603-4953
US

IV. Provider business mailing address

AGUADILLA MEDICAL PLAZA SUITE 201
AGUADILLA PR
00603
US

V. Phone/Fax

Practice location:
  • Phone: 787-882-7380
  • Fax:
Mailing address:
  • Phone: 787-882-7380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number7416
License Number StatePR

VIII. Authorized Official

Name: RIVERA ALMIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-607-3160