Provider Demographics
NPI:1508816091
Name:GRUPO NEUROLOGIA AVANZADA
Entity Type:Organization
Organization Name:GRUPO NEUROLOGIA AVANZADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-744-3490
Mailing Address - Street 1:# 2 MUNOZ RIVERA STREET
Mailing Address - Street 2:PROFESSIONAL CENTER COND.. SUITE 213
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6065
Mailing Address - Country:US
Mailing Address - Phone:787-744-3490
Mailing Address - Fax:787-745-0035
Practice Address - Street 1:# 2 MUNOZ RIVERA STREET
Practice Address - Street 2:SUITE 213 COND. PROFESSIONAL CENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-744-3490
Practice Address - Fax:787-745-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3353170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty