Healthcare Provider Details

I. General information

NPI: 1396404836
Provider Name (Legal Business Name): MMCO PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE 36TH ST STE 202
LIGHTHOUSE POINT FL
33064-7574
US

IV. Provider business mailing address

2100 E SAMPLE RD STE 202
LIGHTHOUSE POINT FL
33064-7574
US

V. Phone/Fax

Practice location:
  • Phone: 954-934-9856
  • Fax: 954-934-9464
Mailing address:
  • Phone: 954-934-9856
  • Fax: 954-934-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA MERCEDES CRISTANCHO
Title or Position: OWNER
Credential: MD
Phone: 954-934-9856