Provider Demographics
NPI:1477956225
Name:PUERTO RICO NEUROSURGERY & SPINE L.L.C.
Entity Type:Organization
Organization Name:PUERTO RICO NEUROSURGERY & SPINE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LASTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-621-3737
Mailing Address - Street 1:369 DORADO BCH E
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2216
Mailing Address - Country:US
Mailing Address - Phone:787-621-3737
Mailing Address - Fax:787-621-3251
Practice Address - Street 1:668 CALLE HERNANDEZ CARRION URB ATENAS MANATI
Practice Address - Street 2:MEDICAL CENTER SUITE 201
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3737
Practice Address - Fax:787-621-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13229207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty