Healthcare Provider Details

I. General information

NPI: 1922321694
Provider Name (Legal Business Name): ACC NEUROLOGY GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AUXILIO MUTUO 715 AVE PONCE DE LEON
SAN JUAN PR
00917
US

IV. Provider business mailing address

PO BOX 194319
SAN JUAN PR
00919-4319
US

V. Phone/Fax

Practice location:
  • Phone: 787-364-1749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: RICARDO ALVARADO
Title or Position: NEUROLOGO
Credential:
Phone: 787-364-1749