Healthcare Provider Details

I. General information

NPI: 1942471206
Provider Name (Legal Business Name): PR NEURO-CARDIOVASCULAR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23-4 AVE ROBERTO CLEMENTE VILLA CAROLINA
CAROLINA PR
00985-5413
US

IV. Provider business mailing address

PO BOX 19191
SAN JUAN PR
00910-1191
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-2697
  • Fax: 787-750-2697
Mailing address:
  • Phone: 787-750-2697
  • Fax: 787-750-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANCISCO J VAZQUEZ REILLO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 787-750-2697