Healthcare Provider Details

I. General information

NPI: 1790307312
Provider Name (Legal Business Name): NEUROVIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 05/07/2024
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 AVENIDA ARTERIAL HOSTOS APARTMENT 405 E
SAN JUAN PR
00918-1472
US

IV. Provider business mailing address

230 AVENIDA ARTERIAL HOSTOS APT 405 E
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-636-0600
  • Fax:
Mailing address:
  • Phone: 939-400-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNESTO EMMANUEL BORRERO SR.
Title or Position: PHYSICIAN,PRESIDENT
Credential: MD
Phone: 787-636-0600