Provider Demographics
NPI:1952683815
Name:MLD PAIN MANAGEMENT INC.
Entity Type:Organization
Organization Name:MLD PAIN MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-998-0088
Mailing Address - Street 1:PO BOX 1558
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-1558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-998-0019
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO SUITE #407
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-998-0088
Practice Address - Fax:787-998-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR157042081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty