Healthcare Provider Details

I. General information

NPI: 1467130278
Provider Name (Legal Business Name): FLORIDA SPINE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11135 S JOG RD STE 5
BOYNTON BEACH FL
33437-1817
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

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