Healthcare Provider Details

I. General information

NPI: 1407401169
Provider Name (Legal Business Name): PREMIER PAIN & SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 159 KM. 13.2 BO. CIBUCO
COROZAL PR
00783
US

IV. Provider business mailing address

PO BOX 2579
BAYAMON PR
00960-2579
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-3140
  • Fax:
Mailing address:
  • Phone: 787-957-3140
  • Fax:

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: LUIS D BAEZ-CABRERA
Title or Position: DIRECTOR
Credential: MD
Phone: 787-810-7682