Provider Demographics
NPI:1790307312
Name:NEUROVIDA LLC
Entity type:Organization
Organization Name:NEUROVIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN,PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:BORRERO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-636-0600
Mailing Address - Street 1:230 AVENIDA ARTERIAL HOSTOS
Mailing Address - Street 2:APT 405 E
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:939-400-8432
Mailing Address - Fax:
Practice Address - Street 1:230 AVENIDA ARTERIAL HOSTOS
Practice Address - Street 2:APARTMENT 405 E
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1472
Practice Address - Country:US
Practice Address - Phone:787-636-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty