Provider Demographics
NPI:1396137964
Name:GRUPO NEUROLOGICO SANTOS DELIZ
Entity type:Organization
Organization Name:GRUPO NEUROLOGICO SANTOS DELIZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-257-1511
Mailing Address - Street 1:1400 AVE DE DIEGO
Mailing Address - Street 2:ESCORIAL BLDG ONE,SUITE 160
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4701
Mailing Address - Country:US
Mailing Address - Phone:787-257-1511
Mailing Address - Fax:787-257-1881
Practice Address - Street 1:1400 AVE DE DIEGO
Practice Address - Street 2:ESCORIAL BLDG ONE,SUITE 160
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4701
Practice Address - Country:US
Practice Address - Phone:787-257-1511
Practice Address - Fax:787-257-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty