Organization
ADVANCED PAIN CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VRAJLAL L RAJYAGURU MD (PRESIDENT)
(407) 935-9404
Entity
Organization
Contact information
Practice address
505 W VINE ST, SUITE 301, KISSIMMEE, FL 34741-4156
(407) 935-9404
(407) 935-9304
Mailing address
505 W VINE ST, SUITE # 301, KISSIMMEE, FL 34741-4156
(407) 935-9404
(407) 935-9304
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME0066759
FL
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME0066759
FL
261QP3300X
Pain Clinic/Center
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377046000
—
FL
Enumeration date
01/06/2006
Last updated
07/21/2022
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