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General NPI Number Information
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NPI Number | 1790810745
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Entity Type | Organization
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Legal Business Name | BOSTON PAIN CLINIC & PRIMARY CARE PC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 188 PROVIDENCE ST
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City | HYDE PARK
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State | MA
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Zip | 02136-1856
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Country | US
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Telephone | 617-361-2166
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Fax | 617-361-2166
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Provider Business Mailing Address
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Address Line | 188 PROVIDENCE ST
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City | HYDE PARK
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State | MA
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Zip | 02136-1856
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Country | US
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Telephone | 617-361-2166
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Fax | 617-364-3871
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Authorized Official
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Title or Position | PAIN MANAGMENT
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Name | DR. ROBERTO FELIZ
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Credential | MD
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Telephone | 617-361-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 79427
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License Number State | MA
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