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General NPI Number Information
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NPI Number | 1316199243
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN CENTER OF SARASOTA INC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 1921 WALDEMERE ST 607
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City | SARASOTA
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State | FL
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Zip | 34239-2943
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Country | US
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Telephone | 941-539-6360
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Fax | 941-870-0958
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Provider Business Mailing Address
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Address Line | PO BOX 39
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City | SARASOTA
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State | FL
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Zip | 34230-0039
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Country | US
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Telephone | 941-539-6360
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Fax | 941-870-0958
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Authorized Official
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Title or Position | DIRECTOR
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Name | MYRDALIS DIAZ-RAMIREZ
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Credential | M.D.
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Telephone | 941-539-6360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME96703
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License Number State | FL
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