Healthcare Provider Details

I. General information

NPI: 1225675804
Provider Name (Legal Business Name): FLORIDA SPINE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD STE 200
BOCA RATON FL
33431-6464
US

IV. Provider business mailing address

670 GLADES RD STE 200
BOCA RATON FL
33431-6464
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-9511
  • Fax: 561-990-7426
Mailing address:
  • Phone: 561-495-9511
  • Fax: 561-990-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY ROSARIO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 561-495-9511