Healthcare Provider Details

I. General information

NPI: 1831599794
Provider Name (Legal Business Name): PAOLO MIMBELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 2
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

PO BOX 223190
HOLLYWOOD FL
33022-3190
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2739
  • Fax:
Mailing address:
  • Phone: 305-974-5533
  • Fax: 305-974-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME15107
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA184629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: