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General NPI Number Information
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NPI Number | 1790307312
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Entity Type | Organization
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Legal Business Name | NEUROVIDA LLC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 230 AVENIDA ARTERIAL HOSTOS APARTMENT 405 E
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City | SAN JUAN
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State | PR
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Zip | 00918-1472
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Country | US
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Telephone | 787-636-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 230 AVENIDA ARTERIAL HOSTOS APT 405 E
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 939-400-8432
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN,PRESIDENT
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Name | MR. ERNESTO EMMANUEL BORRERO SR.
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Credential | MD
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Telephone | 787-636-0600
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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