Healthcare Provider Details

I. General information

NPI: 1396994257
Provider Name (Legal Business Name): N. MIAMI PAIN MANAGEMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 NW 29TH ST
MIAMI FL
33127-3950
US

IV. Provider business mailing address

24 NW 29TH ST
MIAMI FL
33127-3950
US

V. Phone/Fax

Practice location:
  • Phone: 305-573-1375
  • Fax:
Mailing address:
  • Phone: 305-573-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME55385
License Number StateFL

VIII. Authorized Official

Name: DR. PETER SANCHEZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 305-573-1375