=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689841496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMNEURO SPECIALTIES GROUP CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MANATI MEDICAL CENTER SUITE 105 URB ATENAS
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-6066
-----------------------------------------------------
Fax | 787-854-6066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 858
-----------------------------------------------------
City | MANATI
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00674-0858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-854-6066
-----------------------------------------------------
Fax | 787-884-7217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANGELA MANANA DE VELAZQUEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-854-6066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | 261QM2500X
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------