Organization
SUNLAKE PAIN MANAGEMENT, LLC
Active
Other names
Sunlake Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUIS A. LOGRONO MD (MEDICAL DIRECTOR)
(813) 948-2107
Entity
Organization
Contact information
Practice address
18964 DALE MABRY HWY N, STE 101, LUTZ, FL 33548-4913
(813) 948-2107
(813) 948-2790
Mailing address
18964 DALE MABRY HWY N, STE 101, LUTZ, FL 33548-4913
(813) 948-2107
(813) 948-2790
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
HCC8458
FL
Other
Enumeration date
06/01/2009
Last updated
04/01/2010
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