Healthcare Provider Details

I. General information

NPI: 1437887403
Provider Name (Legal Business Name): NEUROPATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SVS PLAZA I LOCAL #208, CARR. #2 KM 149.5 BO. ALGAROBO
MAYAGUEZ PR
00682
US

IV. Provider business mailing address

2770 AVE HOSTOS STE 208
MAYAGUEZ PR
00682-6384
US

V. Phone/Fax

Practice location:
  • Phone: 787-207-3318
  • Fax:
Mailing address:
  • Phone: 787-207-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUIS O DIAZ
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 787-207-3318