Healthcare Provider Details

I. General information

NPI: 1093041444
Provider Name (Legal Business Name): CENTRO NEURODIAGNOSTICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A2 CALLE LODI VILLA LUARCA
SAN JUAN PR
00924-3804
US

IV. Provider business mailing address

A2 CALLE LODI VILLA LUARCA
SAN JUAN PR
00924-3804
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-5955
  • Fax: 787-767-0516
Mailing address:
  • Phone: 787-751-5955
  • Fax: 787-767-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number4731
License Number StatePR

VIII. Authorized Official

Name: NORMA E AGOSTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-751-5955