Healthcare Provider Details

I. General information

NPI: 1619084001
Provider Name (Legal Business Name): PAIN SPECIALIST OF ORLANDO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 SILVER STAR RD
ORLANDO FL
32808-8201
US

IV. Provider business mailing address

6005 SILVER STAR RD
ORLANDO FL
32808-8201
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-5003
  • Fax: 407-299-1471
Mailing address:
  • Phone: 407-299-5003
  • Fax: 407-299-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberHCC5335
License Number StateFL

VIII. Authorized Official

Name: JUANITO T. ESTRADA
Title or Position: PRESIDENT
Credential:
Phone: 407-299-5003