Provider Demographics
NPI:1699907741
Name:SERVICIOS NEUROLOGICOS DEL NOROESTE, C.S.P.
Entity type:Organization
Organization Name:SERVICIOS NEUROLOGICOS DEL NOROESTE, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CARDONA-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-818-0300
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0547
Mailing Address - Country:US
Mailing Address - Phone:787-818-0300
Mailing Address - Fax:
Practice Address - Street 1:CARR 111 KM 2.3
Practice Address - Street 2:BO PALMAR INT.
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-818-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR159262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty