# ADVANCED PAIN CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861470049
- **Authorized official:** DR. VRAJLAL L RAJYAGURU MD (PRESIDENT)
- **Authorized official phone:** (407) 935-9404

## Contact information

- **Practice address:** 505 W VINE ST, SUITE 301, KISSIMMEE, FL 34741-4156
- **Practice address phone:** (407) 935-9404
- **Practice address fax:** (407) 935-9304
- **Mailing address:** 505 W VINE ST, SUITE \# 301, KISSIMMEE, FL 34741-4156
- **Mailing address phone:** (407) 935-9404
- **Mailing address fax:** (407) 935-9304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | ME0066759 | FL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | ME0066759 | FL | Yes |
| 261QP3300X | Pain Clinic/Center | — | FL | — |

## Other

- **Enumeration date:** 01/06/2006
- **Last updated:** 07/21/2022