Healthcare Provider Details

I. General information

NPI: 1659824068
Provider Name (Legal Business Name): PR NEURO CARDIOVASCULAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROBERTO CLEMENTE HSING 33-4
CAROLINA PR
00987-7329
US

IV. Provider business mailing address

BOX 19191 AVE ROBERTO CEMENTE
SAN JUAN PR
00910-9191
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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS MARIA E MELENDEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-750-2697