Provider Demographics
NPI:1477781292
Name:MEDICAL EPILEPSY CARE PSC
Entity type:Organization
Organization Name:MEDICAL EPILEPSY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITA GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-948-2231
Mailing Address - Street 1:LA VILLA DE TORRIMAR
Mailing Address - Street 2:CALLE REY FRANCISCO 332
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-751-2509
Mailing Address - Fax:787-781-5307
Practice Address - Street 1:101 AVE SAN PATRICIO SUITE 1270
Practice Address - Street 2:EDF MARAMAR PLAZA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-751-2509
Practice Address - Fax:787-781-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14,4342084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14,434OtherLIC