Provider Demographics
NPI:1144533746
Name:PUERTO RICO NEUROLOGICAL SPINE SURGERY
Entity type:Organization
Organization Name:PUERTO RICO NEUROLOGICAL SPINE SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:CARDONA DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-723-5553
Mailing Address - Street 1:146 QUINTAS LAS AMERICAS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7910
Mailing Address - Country:US
Mailing Address - Phone:787-522-5454
Mailing Address - Fax:787-522-5473
Practice Address - Street 1:1845 CARR 2 STE 702
Practice Address - Street 2:BAYAMON MEDICAL BUILDING
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7206
Practice Address - Country:US
Practice Address - Phone:787-522-5454
Practice Address - Fax:787-522-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13634207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty