Healthcare Provider Details

I. General information

NPI: 1316917438
Provider Name (Legal Business Name): CENTRO ESPECIALIZADO EN DOLOR DE CABEZAY NEUROLOGIA, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN FRANCISCO TOWER 365 DE DIEGO AVE SUITE 401
SAN JUAN PR
00909
US

IV. Provider business mailing address

COND. PLAYA SERENA 7061 CARR 187 SUITE 401
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5944
  • Fax: 787-765-5786
Mailing address:
  • Phone: 787-767-5944
  • Fax: 787-765-5786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9912
License Number StatePR

VIII. Authorized Official

Name: DR. HECTOR S MIRANDA-DELGADO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-767-5944