Organization
NEW TAMPA INTERVENTIONAL PAIN AND SPORTS MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE DE LA TORRE M.D. (OWNER)
(813) 309-1013
Entity
Organization
Contact information
Practice address
2014 ASHLEY OAKS CIR, SUITE 101, WESLEY CHAPEL, FL 33544-6400
(813) 999-3030
Mailing address
2014 ASHLEY OAKS CIR, SUITE 101, WESLEY CHAPEL, FL 33544-6400
(813) 999-3030
(813) 991-7377
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME89848
FL
208VP0014X
Interventional Pain Medicine Physician
ME89848
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269279100
—
FL
01
—
P00400544
RR MEDICARE
FL
Enumeration date
11/18/2013
Last updated
12/09/2013
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