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NPI Code Detail

MEDICARE: SERVICE PAIN HEALING LABRA INC

MEDICARE: SERVICE PAIN HEALING LABRA INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/CenterHCC7523FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HCC7523OTHERFLAHCA

General Provider Information

NPI Number : 1417082454
Entity Type Code : Organization
Provider Name (Legal Business Name) : SERVICE PAIN HEALING LABRA INC
Provider Business Mailing Address
First Line : 230 S DIXIE HWY
Second Line : SUITE 102
City : LAKE WORTH
State : FL
Zip : 33460-4154
Country : US
Telephone Number : 561-584-0315
Fax Number : 305-675-2668
Provider Business Practice Location Address
First Line : 230 S DIXIE HWY
Second Line : SUITE 102
City : LAKE WORTH
State : FL
Zip : 33460-4154
Country : US
Telephone Number : 561-584-0315
Fax Number : 305-675-2668
Authorized Official
Title or Position : PRESIDENT
Name : MR. OSVALDO LABRADOR LOPEZ
Credential :
Telephone Number : 561-584-0316
Provider Enumeration Date : 02/22/2007
Last Update Date : 08/22/2020

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Directions to “SERVICE PAIN HEALING LABRA INC ” Practice Location

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