Provider Demographics
NPI:1588349153
Name:NEUROSPINE PR LLC
Entity type:Organization
Organization Name:NEUROSPINE PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-616-6894
Mailing Address - Street 1:205-11 SANTANA
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5367
Mailing Address - Country:US
Mailing Address - Phone:787-600-2964
Mailing Address - Fax:787-881-1057
Practice Address - Street 1:619 AVE SAN LUIS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3637
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:787-670-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty