1952683815 NPI number — MLD PAIN MANAGEMENT INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952683815 NPI number — MLD PAIN MANAGEMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MLD PAIN MANAGEMENT INC.
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:
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:
1952683815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1558
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
787-998-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 CALLE SANTA CRUZ
Provider Second Line Business Practice Location Address:
INSTITUTO SAN PABLO SUITE #407
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-7041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-998-0088
Provider Business Practice Location Address Fax Number:
787-998-0019
Provider Enumeration Date:
09/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
ENRIQUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-998-0088

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  15704 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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