Provider Demographics
NPI:1225221625
Name:FLORIDA NEUROSCIENCE L L C
Entity type:Organization
Organization Name:FLORIDA NEUROSCIENCE L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:LOCATELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:954-414-9750
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-414-9750
Mailing Address - Fax:954-414-9752
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:SUITE 504
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-414-9750
Practice Address - Fax:954-414-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME773652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty