1609469402 NPI number — PALM ORTHOPEDICS & INTERVENTIONAL PAIN LLC

Table of content: JUAN FRANCISCO BURGUENO JR (NPI 1073898417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609469402 NPI number — PALM ORTHOPEDICS & INTERVENTIONAL PAIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM ORTHOPEDICS & INTERVENTIONAL PAIN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609469402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16535
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33318-6535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-747-1221
Provider Business Mailing Address Fax Number:
954-747-1231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7710 NW 71ST CT STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33321-2931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-747-1221
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CAMERON
Authorized Official First Name:
JULIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-747-1221

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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