Healthcare Provider Details

I. General information

NPI: 1447020318
Provider Name (Legal Business Name): SPINE PAIN RELIEF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 SW 37TH AVE STE 502
MIAMI FL
33133-2744
US

IV. Provider business mailing address

660 PALM SPRINGS DR STE D
ALTAMONTE SPRINGS FL
32701-7864
US

V. Phone/Fax

Practice location:
  • Phone: 201-925-0277
  • Fax: 888-766-8193
Mailing address:
  • Phone: 201-925-0277
  • Fax: 888-766-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENTIU POPA
Title or Position: OWNER
Credential: MD
Phone: 201-925-0277