Healthcare Provider Details

I. General information

NPI: 1376261883
Provider Name (Legal Business Name): COMPREHENSIVE ARTHRITIS SPINE AND PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 402B
SAINT AUGUSTINE FL
32080-3118
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 402B
SAINT AUGUSTINE FL
32080-3118
US

V. Phone/Fax

Practice location:
  • Phone: 904-325-9420
  • Fax: 469-733-1034
Mailing address:
  • Phone: 904-325-9420
  • Fax: 469-733-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMSHA KUDIA
Title or Position: OWNER
Credential: MD
Phone: 904-325-9420