Provider Demographics
NPI:1366084840
Name:ADVANCED PAIN SOLUTIONS SF LLC
Entity type:Organization
Organization Name:ADVANCED PAIN SOLUTIONS SF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-253-4817
Mailing Address - Street 1:1007 N FEDERAL HWY # 1005
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1422
Mailing Address - Country:US
Mailing Address - Phone:786-253-4817
Mailing Address - Fax:
Practice Address - Street 1:14358 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1206
Practice Address - Country:US
Practice Address - Phone:786-253-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty