Healthcare Provider Details

I. General information

NPI: 1942640800
Provider Name (Legal Business Name): MIAMI PAIN & DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 SW 62ND AVE STE B
SOUTH MIAMI FL
33143-4950
US

IV. Provider business mailing address

7575 SW 62ND AVE STE B
SOUTH MIAMI FL
33143-4950
US

V. Phone/Fax

Practice location:
  • Phone: 305-447-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH E MOUHANNA
Title or Position: OWNER
Credential:
Phone: 305-447-6688