Healthcare Provider Details

I. General information

NPI: 1194491878
Provider Name (Legal Business Name): NRV NEUROPEDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 03/11/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON PARADA 37.5 CLINICAS SUB ESPECIALISTA PEDIATRICAS PISO 1
SAN JUAN PR
00917-5432
US

IV. Provider business mailing address

PO BOX 353
SAN LORENZO PR
00754-0353
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-209-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: NATALIA L RODRIGUEZ VAZQUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-758-2000