Provider Demographics
NPI:1518362714
Name:MS NEUROLOGY
Entity Type:Organization
Organization Name:MS NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RIVERA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-607-3160
Mailing Address - Street 1:AGUADILLA MEDICAL PLAZA SUITE 201
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-882-7380
Mailing Address - Fax:
Practice Address - Street 1:AGUADILLA MALL STE 201
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4953
Practice Address - Country:US
Practice Address - Phone:787-882-7380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7416261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D99606Medicare UPIN