Provider Demographics
NPI:1154403376
Name:TOTAL PAIN MANAGEMENT CLINIC CORP
Entity type:Organization
Organization Name:TOTAL PAIN MANAGEMENT CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAFAELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-306-2720
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:#310
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-223-2003
Mailing Address - Fax:305-223-2555
Practice Address - Street 1:11880 SW 40TH ST
Practice Address - Street 2:#310
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3584
Practice Address - Country:US
Practice Address - Phone:305-223-2003
Practice Address - Fax:305-223-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty