Healthcare Provider Details

I. General information

NPI: 1972566537
Provider Name (Legal Business Name): CENTRO NEUROBIOFISIOLOGICO DE PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 CALLE AMERICA ESQ FRANCIA
SAN JUAN PR
00917-3208
US

IV. Provider business mailing address

CALLE AMERICA 461 ESQ FRANCIA
SAN JUAN PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-294-0812
  • Fax: 787-294-0813
Mailing address:
  • Phone: 787-294-0812
  • Fax: 787-294-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARIA BERMUDEZ
Title or Position: RECURSOS HUMANOS
Credential:
Phone: 787-294-0812