Healthcare Provider Details

I. General information

NPI: 1053439109
Provider Name (Legal Business Name): HOLLYWOOD PAIN MANAGEMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3624
US

IV. Provider business mailing address

2464 N UNIVERSITY DR
PEMBROKE PINES FL
33024-3624
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-9874
  • Fax: 954-885-9876
Mailing address:
  • Phone: 954-885-9874
  • Fax: 954-885-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSEPH MANUEL OSSORIO
Title or Position: MANAGER
Credential: M.D.
Phone: 954-885-9874