Provider Demographics
NPI:1720488596
Name:PR PAIN GROUP LLC
Entity Type:Organization
Organization Name:PR PAIN GROUP LLC
Other - Org Name:DR HECTOR DELUCCA LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCCA JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-955-8100
Mailing Address - Street 1:CONSOLIDATED MEDICAL PLAZA SUITE 307A
Mailing Address - Street 2:201 AVE GAUTIER BENITEZ
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2715
Mailing Address - Country:US
Mailing Address - Phone:787-957-8282
Mailing Address - Fax:787-665-1165
Practice Address - Street 1:CONSOLIDATED MEDICAL PLAZA 201 AVE GAUTIER BENITEZ
Practice Address - Street 2:STE 307A
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-957-8282
Practice Address - Fax:787-665-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR206192081P2900X, 208VP0014X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty