Healthcare Provider Details

I. General information

NPI: 1891651204
Provider Name (Legal Business Name): NOVA NEURO PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND BELAIR # MANGO174
GUAYNABO PR
00968-4401
US

IV. Provider business mailing address

COND BELAIR # MANGO174
GUAYNABO PR
00968-4401
US

V. Phone/Fax

Practice location:
  • Phone: 787-349-1589
  • Fax:
Mailing address:
  • Phone: 787-349-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: WILMARY RAMOS SOTO
Title or Position: PSICOLOGA
Credential: LCDA.
Phone: 787-349-1589