Healthcare Provider Details

I. General information

NPI: 1487354841
Provider Name (Legal Business Name): PUERTO RICO MULTIPLE SCLEROSIS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 05/22/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 AVE DEGETAU HIMA PLAZA 1 SUITE 308 PISO 3
CAGUAS PR
00725-7303
US

IV. Provider business mailing address

500 AVE DEGETAU HIMA PLAZA I SUITE 308 PISO 3
CAGUAS PR
00725-7303
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-7678
  • Fax: 787-474-7680
Mailing address:
  • Phone: 787-474-7678
  • Fax: 787-474-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE AVILA ORNELAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-474-7678