Provider Demographics
NPI:1467736702
Name:THE PALMS INTERVENTIONAL PAIN CLINIC, PSC
Entity Type:Organization
Organization Name:THE PALMS INTERVENTIONAL PAIN CLINIC, PSC
Other - Org Name:THE PALMS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-200-0350
Mailing Address - Street 1:URB. VALLE ARRIBA HEIGHTS
Mailing Address - Street 2:ST. 110 BH 2
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-200-0350
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 # INT839
Practice Address - Street 2:SECTOR LA ALDEA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-200-0350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16381261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCY164AOtherPTAN