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General NPI Number Information
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NPI Number | 1053183111
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Entity Type | Organization
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Legal Business Name | PREMIER PAIN INC
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 9050 PINES BLVD STE 301
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6422
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Country | US
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Telephone | 754-888-9080
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Fax | 754-888-9280
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Provider Business Mailing Address
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Address Line | 9050 PINES BLVD STE 301
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6422
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Country | US
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Telephone | 754-888-9080
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Fax | 754-888-9280
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Authorized Official
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Title or Position | OWNER
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Name | NINEDTY CORDOVA
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Credential | APRN
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Telephone | 754-888-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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