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General NPI Number Information
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NPI Number | 1992173009
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Entity Type | Organization
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Legal Business Name | PAIN RELIEF REHAB MEDICAL CENTER, CORP
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 3750 W 16TH AVE STE 138U
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City | HIALEAH
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State | FL
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Zip | 33012-4661
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Country | US
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Telephone | 786-346-4141
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Fax | 786-346-4142
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Provider Business Mailing Address
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Address Line | 3750 W 16TH AVE STE 138U
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City | HIALEAH
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State | FL
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Zip | 33012-4661
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Country | US
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Telephone | 786-346-4141
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Fax | 786-346-4142
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Authorized Official
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Title or Position | PRESIDENT
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Name | FAUSTO P CASTILLO
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Credential | MD
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Telephone | 786-346-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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