Provider Demographics
NPI:1629475447
Name:KENDALL PAIN MANAGEMENT CENTER CORP
Entity Type:Organization
Organization Name:KENDALL PAIN MANAGEMENT CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAUSTO
Authorized Official - Middle Name:PENA
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-616-8511
Mailing Address - Street 1:9260 SUNSET DR STE 219
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3255
Mailing Address - Country:US
Mailing Address - Phone:786-616-8511
Mailing Address - Fax:
Practice Address - Street 1:9260 SUNSET DR STE 219
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3255
Practice Address - Country:US
Practice Address - Phone:786-616-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME17657261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service