Provider Demographics
NPI:1407401169
Name:PREMIER PAIN & SPINE SPECIALISTS LLC
Entity Type:Organization
Organization Name:PREMIER PAIN & SPINE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAEZ-CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-810-7682
Mailing Address - Street 1:PO BOX 2579
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2579
Mailing Address - Country:US
Mailing Address - Phone:787-957-3140
Mailing Address - Fax:
Practice Address - Street 1:CARR. 159 KM. 13.2 BO. CIBUCO
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-957-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain