Healthcare Provider Details

I. General information

NPI: 1720488596
Provider Name (Legal Business Name): PR PAIN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CALLE GAUTIER BENITEZ STE 400
CAGUAS PR
00725-5527
US

IV. Provider business mailing address

201 CALLE GAUTIER BENITEZ STE 400
CAGUAS PR
00725-5527
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-8282
  • Fax: 787-665-1165
Mailing address:
  • Phone: 787-988-2155
  • Fax: 787-665-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20619
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20619
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HECTOR DELUCCA JIMENEZ
Title or Position: PRESIDENT OWNER
Credential:
Phone: 787-955-8100