Provider Demographics
NPI:1316917438
Name:CENTRO ESPECIALIZADO EN DOLOR DE CABEZA Y NEUROLOGIA
Entity type:Organization
Organization Name:CENTRO ESPECIALIZADO EN DOLOR DE CABEZA Y NEUROLOGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-767-5944
Mailing Address - Street 1:365 DE DIEGO AVE
Mailing Address - Street 2:SAN FRANCISCO TOWER SUITE 409
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-767-5944
Mailing Address - Fax:787-765-5786
Practice Address - Street 1:365 DE DIEGO AVE
Practice Address - Street 2:SAN FRANCISCO TOWER SUITE 409
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-5944
Practice Address - Fax:787-765-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR99122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E63380Medicare UPIN
83816Medicare ID - Type Unspecified