Provider Demographics
NPI:1871515460
Name:NEUMOVIDA PSC
Entity type:Organization
Organization Name:NEUMOVIDA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-780-2877
Mailing Address - Street 1:503 CAMINO DE CAMBALACHE
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-3643
Mailing Address - Country:US
Mailing Address - Phone:787-780-2877
Mailing Address - Fax:787-780-2878
Practice Address - Street 1:503 CAMINO DE CAMBALACHE
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-3643
Practice Address - Country:US
Practice Address - Phone:787-780-2877
Practice Address - Fax:787-780-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1871515460Medicaid