Healthcare Provider Details

I. General information

NPI: 1881207587
Provider Name (Legal Business Name): DIAGNOSTIC & INTERVENTIONAL SPINE CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 NW 26TH ST STE 16
DORAL FL
33172-1628
US

IV. Provider business mailing address

8726 NW 26TH ST STE 16
DORAL FL
33172-1628
US

V. Phone/Fax

Practice location:
  • Phone: 786-640-0604
  • Fax: 786-640-0605
Mailing address:
  • Phone: 786-640-0604
  • Fax: 786-640-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NABIL H. HODROJ
Title or Position: OWNER
Credential: DO
Phone: 786-640-0604