Healthcare Provider Details

I. General information

NPI: 1700419595
Provider Name (Legal Business Name): ANTIPAIN LIFESTYLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 W. WILLIAM CANNON DR. BUILDING SEVEN, SUITE 102
AUSTIN TX
78749-1216
US

IV. Provider business mailing address

PO BOX 92844
AUSTIN TX
78709-2844
US

V. Phone/Fax

Practice location:
  • Phone: 669-237-2239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA RUIZ CADY
Title or Position: DIRECTOR
Credential: DO
Phone: 669-237-2239