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General NPI Number Information
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NPI Number | 1326452822
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Entity Type | Organization
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Legal Business Name | ADVANCED ANALGESIA AND ANESTHESIA, INC
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 515 W STATE ROAD 434 SUITE 110
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City | LONGWOOD
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State | FL
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Zip | 32750-4981
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Country | US
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Telephone | 407-645-2661
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Fax |
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Provider Business Mailing Address
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Address Line | 515 W STATE ROAD 434 SUITE 110
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City | LONGWOOD
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State | FL
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Zip | 32750-4981
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Country | US
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Telephone | 407-645-2661
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MRS. AMANDA MARTINEZ
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Credential |
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Telephone | 818-340-0265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME87839
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License Number State | FL
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