Organization · NPI-2

Treasure Coast Neurology, INC

Psychiatry & Neurology, Neurology · Fort Pierce, FL

NPI number1760004501
StatusActive
Last updated in NPPESMay 15, 2020

Details

NPI
1760004501
Entity type
Organization (NPI-2)
Legal business name
Treasure Coast Neurology, INC
Organization subpart
No
Enumeration date
May 14, 2020
Certification date
May 15, 2020
Last updated
May 15, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084N0400X Psychiatry & Neurology, Neurology––Yes
261QM2500X Clinic/Center, Medical Specialty––

Practice location

2401 Frist Blvd Ste 2b
Fort Pierce, FL 34950-4800

Phone 772-528-1310

Mailing address

2401 Frist Blvd Ste 2b
Fort Pierce, FL 34950-4800

Phone 772-528-1310

Authorized official

Raul Eduardo Montejo
Owner/Neurologist
7725281310

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