Healthcare Provider Details

I. General information

NPI: 1114159118
Provider Name (Legal Business Name): OPA-LOCKA PAIN MANAGEMENT, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4805
US

IV. Provider business mailing address

1865 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4805
US

V. Phone/Fax

Practice location:
  • Phone: 305-948-9958
  • Fax: 305-948-9518
Mailing address:
  • Phone: 305-948-9958
  • Fax: 305-948-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME050431
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN G PADRON
Title or Position: DIRECTOR/OWNER
Credential: M.D.
Phone: 305-948-9958