Organization
ADVANCED PAIN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VRAJLAL L RAJYAGURU MD (MEDICAL DIRECTOR)
(407) 935-9404
Entity
Organization
Contact information
Practice address
3901 E COLONIAL DR, ORLANDO, FL 32803-5245
(407) 935-9404
Mailing address
505 W VINE ST, 301, KISSIMMEE, FL 34741-4123
(407) 935-9404
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME0066759
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377046000
—
FL
Enumeration date
05/14/2008
Last updated
05/14/2008
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