Healthcare Provider Details

I. General information

NPI: 1790073831
Provider Name (Legal Business Name): RELIEF OF PAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W HILLSBOROUGH AVE
TAMPA FL
33603-1312
US

IV. Provider business mailing address

1030 W HILLSBOROUGH AVE
TAMPA FL
33603-1312
US

V. Phone/Fax

Practice location:
  • Phone: 813-644-7035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: JOSE GONZALEZ
Title or Position: MANAGER
Credential:
Phone: 813-644-7035