Healthcare Provider Details

I. General information

NPI: 1225029705
Provider Name (Legal Business Name): SOUTH FLORIDA INSTITUTE OF PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10887 NW 17TH ST UNIT 108
MIAMI FL
33172-2044
US

IV. Provider business mailing address

10887 NW 17TH ST UNIT 108
MIAMI FL
33172-2044
US

V. Phone/Fax

Practice location:
  • Phone: 786-359-4999
  • Fax: 786-359-4843
Mailing address:
  • Phone: 786-359-4999
  • Fax: 786-359-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7589
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME86935
License Number StateFL

VIII. Authorized Official

Name: BAYRON MALGOR
Title or Position: OWNER
Credential:
Phone: 305-484-9205