Healthcare Provider Details

I. General information

NPI: 1902013261
Provider Name (Legal Business Name): PURA VIDA PAIN CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E BUSCH BLVD UNIT A
TAMPA FL
33617-6416
US

IV. Provider business mailing address

4801 E BUSCH BLVD UNIT A
TAMPA FL
33617-6416
US

V. Phone/Fax

Practice location:
  • Phone: 813-980-6700
  • Fax: 813-980-6711
Mailing address:
  • Phone: 813-980-6700
  • Fax: 813-980-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHIARA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 813-980-6700