Provider Demographics
NPI:1770722381
Name:MEDICAL EPILEPCY CARE PSC
Entity type:Organization
Organization Name:MEDICAL EPILEPCY CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITA GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-948-2231
Mailing Address - Street 1:LA VILLA DE TORRIMAR
Mailing Address - Street 2:CALLE REY FRANCISCO 332
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-949-2231
Mailing Address - Fax:787-268-7271
Practice Address - Street 1:TORRE DE PLAZA LAS AMERICAS, PLAZA MED
Practice Address - Street 2:SUITE 402, PLAZA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-949-2231
Practice Address - Fax:787-268-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR144342084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14434OtherLIC