Provider Demographics
NPI:1790307312
Name:NEUROVIDA L.L.C
Entity Type:Organization
Organization Name:NEUROVIDA L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:BORRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-636-0600
Mailing Address - Street 1:230 AVE ARTERIAL HOSTOS 405E
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO (PR)
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 AVE ARTERIAL HOSTOS APT 405E
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1472
Practice Address - Country:US
Practice Address - Phone:787-636-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty