Provider Demographics
NPI:1053748418
Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE ENFERMEDADES NEUROLOGICAS CSP
Entity type:Organization
Organization Name:CENTRO DE DIAGNOSTICO Y TRATAMIENTO DE ENFERMEDADES NEUROLOGICAS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:STELLA-ARRILLAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-754-0145
Mailing Address - Street 1:420 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3416
Mailing Address - Country:US
Mailing Address - Phone:787-754-0145
Mailing Address - Fax:787-764-3342
Practice Address - Street 1:420 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3416
Practice Address - Country:US
Practice Address - Phone:787-754-0145
Practice Address - Fax:787-764-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHT211AOtherPTAN
PRHT211AOtherPTAN