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351 Ave Hostos Ste 309 Mayaguez PR 00680-1504 | |
| (787) 805-7319 | |
| (787) 805-0577 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 351 Ave Hostos Ste 309, Mayaguez, Puerto Rico |
| Authorized Official Name and Position | Merbil R Gonzalez-diaz (PRESIDENT) |
| Authorized Official Contact | 7878057319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
351 Ave Hostos Ste 309 Mayaguez PR 00680-1504 Ph: (787) 805-7319 | 351 Ave Hostos Ste 309 Mayaguez PR 00680-1504 Ph: (787) 805-7319 |
| NPI Number | 1780975607 |
|---|---|
| Provider Enumeration Date | 04/26/2011 |
| Last Update Date | 04/26/2011 |
| Medicare PECOS PAC ID | 5395914261 |
|---|---|
| Medicare Enrollment ID | O20110810000246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780975607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | 13818 (Puerto Rico) | Primary |
| Provider Name | Merbil R Gonzalez Diaz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1902878614 PECOS PAC ID: 7618972100 Enrollment ID: I20060915000048 |
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