Healthcare Provider Details

I. General information

NPI: 1609477934
Provider Name (Legal Business Name): PAIN INTERVENTION ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 37TH ST STE C103
VERO BEACH FL
32960-7301
US

IV. Provider business mailing address

777 37TH ST STE C103
VERO BEACH FL
32960-7301
US

V. Phone/Fax

Practice location:
  • Phone: 561-352-7413
  • Fax:
Mailing address:
  • Phone: 772-971-6096
  • Fax: 949-561-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JESSICA ANNE OLSEN
Title or Position: MD
Credential: MD
Phone: 772-971-6096