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General NPI Number Information
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NPI Number | 1780975607
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Entity Type | Organization
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Legal Business Name | CENTRO DE SERVICIOS NEUROLOGICOS DE MAYAGUEZ, CSP
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 351 AVE HOSTOS STE 309
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City | MAYAGUEZ
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State | PR
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Zip | 00680-1504
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Country | US
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Telephone | 787-805-7319
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Fax | 787-805-0577
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Provider Business Mailing Address
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Address Line | 351 AVE HOSTOS STE 309
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City | MAYAGUEZ
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State | PR
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Zip | 00680-1504
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Country | US
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Telephone | 787-805-7319
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Fax | 787-805-0577
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MERBIL R GONZALEZ-DIAZ
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Credential | M.D.
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Telephone | 787-805-7319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 13818
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License Number State | PR
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