Provider Demographics
NPI:1972566537
Name:CENTRO NEUROBIOFISIOLOGICO DE PR
Entity Type:Organization
Organization Name:CENTRO NEUROBIOFISIOLOGICO DE PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECURSOS HUMANOS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-294-0812
Mailing Address - Street 1:CALLE AMERICA 461
Mailing Address - Street 2:ESQ FRANCIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-294-0812
Mailing Address - Fax:787-294-0813
Practice Address - Street 1:461 CALLE AMERICA
Practice Address - Street 2:ESQ FRANCIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3208
Practice Address - Country:US
Practice Address - Phone:787-294-0812
Practice Address - Fax:787-294-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0053464Medicare ID - Type Unspecified