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General NPI Number Information
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NPI Number | 1295593150
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN MANAGEMENT AND REGENERATIVE MEDICINE OF THE PALM B
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 3319 S STATE ROAD 7 STE 102
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City | WELLINGTON
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State | FL
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Zip | 33449-8099
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Country | US
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Telephone | 561-436-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 3319 S STATE ROAD 7 STE 102
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City | WELLINGTON
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State | FL
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Zip | 33449-8099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HUMBERTO PORRATA NIEVA
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Credential | MD
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Telephone | 561-436-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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