Provider Demographics
NPI:1093041444
Name:CENTRO NEURODIAGNOSTICO, INC.
Entity Type:Organization
Organization Name:CENTRO NEURODIAGNOSTICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-751-5955
Mailing Address - Street 1:A2 CALLE LODI
Mailing Address - Street 2:VILLA LUARCA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3804
Mailing Address - Country:US
Mailing Address - Phone:787-751-5955
Mailing Address - Fax:787-767-0516
Practice Address - Street 1:A2 CALLE LODI
Practice Address - Street 2:VILLA LUARCA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3804
Practice Address - Country:US
Practice Address - Phone:787-751-5955
Practice Address - Fax:787-767-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4731293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory