Healthcare Provider Details

I. General information

NPI: 1033509971
Provider Name (Legal Business Name): INTERVENTIONAL SPINE AND PAIN, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 07/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17051 NORTH DALLAS PARKWAY SUITE 300
ADDISON TX
75001
US

IV. Provider business mailing address

12221 MERIT DR STE 620
DALLAS TX
75251-3222
US

V. Phone/Fax

Practice location:
  • Phone: 214-506-2610
  • Fax: 214-506-1170
Mailing address:
  • Phone: 214-506-2610
  • Fax: 972-681-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PABLO ZEBALLOS
Title or Position: OWNER
Credential: DO
Phone: 214-506-2610