Basic Information
| Provider Information | |||||||||
| NPI: | 1972126258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROPEDEEGPR LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PMB 331 GRAN PASEOS BOULEVARD 100 | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009266507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875473989 | ||||||||
| FaxNumber: | 7879216529 | ||||||||
| Practice Location | |||||||||
| Address1: | CALLE SAN JORGE #258 SAN JORGE MEDICAL BUILDING SUITE 3 | ||||||||
| Address2: | |||||||||
| City: | SANTURCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877271000 | ||||||||
| FaxNumber: | 7877596756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2020 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | RIOS | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 7875473989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | Y | Laboratories | Physiological Laboratory |
No ID Information.