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NPI Code Detail

MEDICARE: NEW SERVICE PAIN LEJANDRO INC

MEDICARE: NEW SERVICE PAIN LEJANDRO INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/CenterHCC7558FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1HCC7558OTHERFLAHCA LICENSE

General Provider Information

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

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Directions to “NEW SERVICE PAIN LEJANDRO INC ” Practice Location

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