Provider Demographics
NPI:1134368822
Name:WESTERN NEONATAL SERVICES, CSP
Entity type:Organization
Organization Name:WESTERN NEONATAL SERVICES, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-8280
Mailing Address - Street 1:EDIF MEDICO IV # OFIC203
Mailing Address - Street 2:CALLE DR BASORA 55N
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4810
Mailing Address - Country:US
Mailing Address - Phone:787-834-8280
Mailing Address - Fax:787-834-8280
Practice Address - Street 1:EDIF MEDICO IV # OFIC203
Practice Address - Street 2:CALLE DR BASORA 55N
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-834-8280
Practice Address - Fax:787-834-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR93382080N0001X
PR57742080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty