Healthcare Provider Details

I. General information

NPI: 1962169227
Provider Name (Legal Business Name): LITTLE ANGEL'S NEUROLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MONTELLANO CARR 14 KM 72
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 373206
CAYEY PR
00737-3206
US

V. Phone/Fax

Practice location:
  • Phone: 939-419-8866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUISA FERNANDA ANGEL BUITRAGO
Title or Position: PRESIDENT
Credential: MD
Phone: 939-419-8866