=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649709114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN FOR LESS WELLCARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8732 NW 119TH ST STE 3
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-1991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-485-3923
-----------------------------------------------------
Fax | 786-485-3941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8732 NW 119TH ST STE 3
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-1991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-485-3923
-----------------------------------------------------
Fax | 786-485-3941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ARIEL SANCHEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-485-3923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------