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General NPI Number Information
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NPI Number | 1568755023
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Entity Type | Organization
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Legal Business Name | NORTH PARK PAIN MANAGEMENT
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 3956 W HILLSBOROUGH AVE
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City | TAMPA
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State | FL
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Zip | 33614-5628
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Country | US
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Telephone | 813-610-9213
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Fax |
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Provider Business Mailing Address
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Address Line | 3956 W HILLSBOROUGH AVE
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City | TAMPA
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State | FL
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Zip | 33614-5628
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Country | US
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Telephone | 813-610-9213
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSE JAVIER ALONSO SR.
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Credential |
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Telephone | 813-889-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | HCC8945
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License Number State | FL
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