MEDICARE: ONSITE NEUROLOGY AND RADIOLOGY OF PUERTO RICO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	11290	PR

General Provider Information

NPI Number	:	1548401078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONSITE NEUROLOGY AND RADIOLOGY OF PUERTO RICO

Provider Business Mailing Address
First Line	:	89 AVE DE DIEGO
Second Line	:	SUITE 105/408
City	:	SAN JUAN
State	:	PR
Zip	:	00927-6372
Country	:	US
Telephone Number	:	888-395-4007
Fax Number	:	888-395-3941

Provider Business Practice Location Address
First Line	:	1413 AVE FERNANDEZ JUNCOS
Second Line	:	SUITE 2-C
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2649
Country	:	US
Telephone Number	:	888-395-4007
Fax Number	:	888-395-3941

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	NELSON COLON
Credential	:	MD
Telephone Number	:	888-395-4007

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	03/12/2009

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Directions to “ONSITE NEUROLOGY AND RADIOLOGY OF PUERTO RICO ” Practice Location

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