Provider Demographics
NPI:1972126258
Name:NEUROPEDEEGPR LLC
Entity Type:Organization
Organization Name:NEUROPEDEEGPR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-547-3989
Mailing Address - Street 1:PMB 331 GRAN PASEOS BOULEVARD 100
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6507
Mailing Address - Country:US
Mailing Address - Phone:787-547-3989
Mailing Address - Fax:787-921-6529
Practice Address - Street 1:CALLE SAN JORGE #258 SAN JORGE MEDICAL BUILDING SUITE 3
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-727-1000
Practice Address - Fax:787-759-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory