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General NPI Number Information
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NPI Number | 1467736702
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Entity Type | Organization
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Legal Business Name | THE PALMS INTERVENTIONAL PAIN CLINIC, PSC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | CARR 167 # INT839 SECTOR LA ALDEA
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City | BAYAMON
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State | PR
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Zip | 00961-4477
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Country | US
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Telephone | 787-200-0350
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Fax |
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Provider Business Mailing Address
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Address Line | URB. VALLE ARRIBA HEIGHTS ST. 110 BH 2
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-200-0350
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VICTOR F RODRIGUEZ
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Credential | MD
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Telephone | 787-200-0350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 16381
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License Number State | PR
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