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General NPI Number Information
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NPI Number | 1568794857
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Entity Type | Organization
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Legal Business Name | SOUTH DADE PAIN CENTER LLC
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 9847 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3993
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Country | US
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Telephone | 305-228-8605
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Fax | 305-228-8604
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Provider Business Mailing Address
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Address Line | 9847 SW 40TH ST
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City | MIAMI
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State | FL
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Zip | 33165-3993
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Country | US
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Telephone | 305-228-8605
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Fax | 305-228-8604
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Authorized Official
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Title or Position | OWNER
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Name | RAFAEL F AVILES
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Credential | MD
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Telephone | 305-228-8605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME67736
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License Number State | FL
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