Healthcare Provider Details

I. General information

NPI: 1477302560
Provider Name (Legal Business Name): PAIN SPECIALISTS OF KENDALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12340 SW 132ND CT
MIAMI FL
33186-6451
US

IV. Provider business mailing address

12340 SW 132ND CT
MIAMI FL
33186-6451
US

V. Phone/Fax

Practice location:
  • Phone: 786-250-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSSEL CALVEIRO
Title or Position: MANAGER
Credential:
Phone: 305-244-1041