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NPI Code Detail

MEDICARE: NEUROMOVEMENT MMG, LLC

MEDICARE: NEUROMOVEMENT MMG, LLC
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
12084N0400XNeurology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121514OTHERPRMEDICAL STATE LICENSE

General Provider Information

NPI Number : 1639878697
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEUROMOVEMENT MMG, LLC
Provider Business Mailing Address
First Line : 381 AVE. FELISA RINCON DE GAUTIER
Second Line : CONDOMINIO PASEO MONTE APT 1501
City : SAN JUAN
State : PR
Zip : 00926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 133 CALLE MANUEL DOMENECH
Second Line :
City : SAN JUAN
State : PR
Zip : 00918-3501
Country : US
Telephone Number : 787-399-1551
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. MELISSA A MORALES GARCIA
Credential : MD
Telephone Number : 787-399-1551
Provider Enumeration Date : 02/28/2023
Last Update Date : 02/28/2023

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Directions to “NEUROMOVEMENT MMG, LLC ” Practice Location

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