Provider Demographics
NPI:1922136829
Name:CENTRO NEUROLOGICO Y VASCULAR DE PUERTO RICO
Entity Type:Organization
Organization Name:CENTRO NEUROLOGICO Y VASCULAR DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-781-6539
Mailing Address - Street 1:COND VILLA CAPARRA EXECUTIVE
Mailing Address - Street 2:229 CARR. # 2 APT 15F
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1945
Mailing Address - Country:US
Mailing Address - Phone:787-781-6539
Mailing Address - Fax:787-781-6539
Practice Address - Street 1:101 AVE SAN PATRICIO
Practice Address - Street 2:SUITE 870
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-783-3460
Practice Address - Fax:787-783-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR135742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021030Medicare ID - Type Unspecified
PRH66545Medicare UPIN