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General NPI Number Information
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NPI Number | 1770607178
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Entity Type | Organization
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Legal Business Name | NEW SERVICE PAIN LEJANDRO INC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 224 DATURA ST SUITE 200
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5624
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Country | US
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Telephone | 305-509-0602
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Fax | 305-675-2668
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Provider Business Mailing Address
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Address Line | 224 DATURA ST SUITE 200
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5624
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Country | US
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Telephone | 305-509-0602
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Fax | 305-675-2668
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEJANDRO RIVAS
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Credential |
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Telephone | 305-509-0602
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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 | HCC7558
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License Number State | FL
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