Healthcare Provider Details

I. General information

NPI: 1841105715
Provider Name (Legal Business Name): GENESIS NEUROLOGIA PEDIATRICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S-3 #1 CARR 21 URB LAS LOMAS
SAN JUAN PR
00921-4225
US

IV. Provider business mailing address

PO BOX 405
SAN LORENZO PR
00754-0405
US

V. Phone/Fax

Practice location:
  • Phone: 787-396-0014
  • Fax:
Mailing address:
  • Phone: 787-396-0014
  • 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

VIII. Authorized Official

Name: DR. GENESIS N AYALA LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 787-396-0014