Provider Demographics
NPI:1396638789
Name:NORTH COAST PAIN CENTER SRL
Entity type:Organization
Organization Name:NORTH COAST PAIN CENTER SRL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:849-506-4223
Mailing Address - Street 1:8400 NW 25TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33198-1534
Mailing Address - Country:US
Mailing Address - Phone:214-718-5922
Mailing Address - Fax:
Practice Address - Street 1:CALLE CAMINO DEL SOL PLAZA SOL TROPICAL , LOCAL #5
Practice Address - Street 2:CALLE CAMINO DEL SOL PLAZA SOL TROPICAL , LOCAL #5
Practice Address - City:CABARETE
Practice Address - State:DOMINICAN REPUBLIC
Practice Address - Zip Code:57111
Practice Address - Country:DO
Practice Address - Phone:849-506-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care