Healthcare Provider Details

I. General information

NPI: 1205592862
Provider Name (Legal Business Name): SVPMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6522
US

IV. Provider business mailing address

2047 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6522
US

V. Phone/Fax

Practice location:
  • Phone: 561-507-0800
  • Fax:
Mailing address:
  • Phone: 561-507-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIANNE IRENE YANTZ
Title or Position: HR
Credential:
Phone: 561-507-0800