Healthcare Provider Details

I. General information

NPI: 1952587313
Provider Name (Legal Business Name): BAYAMON NEUROLOGY SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL PLAZA AVE #2 906
BAYAMON PR
00961
US

IV. Provider business mailing address

BAYAMON MEDICAL PLAZA AVE #2 906
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-7123
  • Fax: 787-785-1153
Mailing address:
  • Phone: 787-740-7123
  • Fax: 787-785-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number13531
License Number StatePR

VIII. Authorized Official

Name: DR. JAIME ROSA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-740-7123