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General NPI Number Information
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NPI Number | 1114159118
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Entity Type | Organization
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Legal Business Name | OPA-LOCKA PAIN MANAGEMENT, CORP
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 1865 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4805
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Country | US
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Telephone | 305-948-9958
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Fax | 305-948-9518
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Provider Business Mailing Address
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Address Line | 1865 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-4805
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Country | US
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Telephone | 305-948-9958
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Fax | 305-948-9518
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. JOHN G PADRON
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Credential | M.D.
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Telephone | 305-948-9958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME050431
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License Number State | FL
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