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NPI Code Detail

MEDICARE: PONCE NEUROLOGICAL CONSULTANTS INC.

MEDICARE: PONCE NEUROLOGICAL CONSULTANTS INC.
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 Physician16476PR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1195703OTHERPRDEPARTAMENTO DE ESTADO

General Provider Information

NPI Number : 1912214040
Entity Type Code : Organization
Provider Name (Legal Business Name) : PONCE NEUROLOGICAL CONSULTANTS INC.
Provider Business Mailing Address
First Line : 909 AVE TITO CASTRO
Second Line : SUITE 804
City : PONCE
State : PR
Zip : 00716-4725
Country : US
Telephone Number : 787-648-8115
Fax Number : 787-651-1498
Provider Business Practice Location Address
First Line : 909 AVE TITO CASTRO
Second Line : SUITE 804
City : PONCE
State : PR
Zip : 00716-4725
Country : US
Telephone Number : 787-648-8115
Fax Number : 787-651-1498
Authorized Official
Title or Position : PRESIDENT
Name : RICARDO VILLALOBOS
Credential : M.D.
Telephone Number : 787-648-8115
Provider Enumeration Date : 09/10/2010
Last Update Date : 09/10/2010

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1861804197 — DR RICARDO VILLALOBOS GONZALEZ PSC
Practice Location Address:
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Directions to “PONCE NEUROLOGICAL CONSULTANTS INC. ” Practice Location

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