Healthcare Provider Details

I. General information

NPI: 1104107697
Provider Name (Legal Business Name): NEUROLOGICMD P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE JESUS T PINERO # 282 EDIFICIO PLAZA EL AMAL SUITE 210
SAN JUAN PR
00918-4003
US

IV. Provider business mailing address

AVE JESUS T PINERO # 282 EDIFICIO PLAZA EL AMAL SUITE 210
SAN JUAN PR
00918-4003
US

V. Phone/Fax

Practice location:
  • Phone: 787-772-5555
  • Fax: 787-772-3535
Mailing address:
  • Phone: 787-772-5555
  • Fax: 787-772-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number16446
License Number StatePR

VIII. Authorized Official

Name: DR. ELIUD IRIZARRY CLAUDIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-772-5555