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General NPI Number Information
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NPI Number | 1306347497
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Entity Type | Organization
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Legal Business Name | NEURO HOUSE. LLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | EDIFICIO CENTER PLEX CARR 2 KM 133.5 SUITE 309
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-589-7272
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | AGUADA
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State | PR
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Zip | 00602-0548
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Country | US
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Telephone | 787-589-7272
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Fax |
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Authorized Official
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Title or Position | CHILD NEUROLOGY
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Name | DR. MARIE BERNADINE V. HIDALGO-RIVERA
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Credential | MD
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Telephone | 787-589-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 18252
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License Number State | PR
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