Individual provider Active NPI

Glenn Joseph Garayalde, M.D.

  • Neurology Physician
  • San Juan, PR
National Provider Identifier
1619946035
Registry record updated Sep 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
6229 Issued in PR
Practice address
1452 Ashford Ave
Suite 411 a Condo Ada Ligia
San Juan, PR 00907
Phone
(787) 723-1735
Fax
(787) 723-1736
NPI assigned
Mar 16, 2006
Last updated
Sep 21, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 6229 PR Primary

Addresses

Primary practice location

1452 Ashford Ave
Suite 411 a Condo Ada Ligia
San Juan, PR 00907

Mailing address

PO Box 361976
San Juan, PR 00936-1976
Phone (787) 723-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110624000246 PR Practitioner - Neurology 4587842422 Practice locations: San Juan, PR

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Puerto Rico School of Medicine, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1789 Carretera 21 Urb Las Lomas
Torre del Metropolitano Suite 305
San Juan, PR 00922
Phone (787) 723-1735

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6229PRMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Cardiostat Medical Testing Services Past Accepting new patients
GMG Diagnostic Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285027200000",
    "number": "1619946035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 361976",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009361976",
            "telephone_number": "787-723-1735",
            "fax_number": "787-723-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1452 ASHFORD AVE",
            "address_2": "SUITE 411 A CONDO ADA LIGIA",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00907",
            "telephone_number": "787-723-1735",
            "fax_number": "787-723-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARAYALDE",
        "first_name": "GLENN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2010-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PR",
            "license": "6229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.