Provider Demographics
NPI:1790073039
Name:PROFESSIONAL PAIN REHAB CORP
Entity Type:Organization
Organization Name:PROFESSIONAL PAIN REHAB CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-366-9833
Mailing Address - Street 1:5040 NW 7TH ST
Mailing Address - Street 2:SUITE 635
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST
Practice Address - Street 2:SUITE 635
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3422
Practice Address - Country:US
Practice Address - Phone:786-366-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation