Healthcare Provider Details

I. General information

NPI: 1629413885
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 W 20TH AVE SUITE 209
HIALEAH FL
33016-5531
US

IV. Provider business mailing address

660 GLADES ROAD SUITE 460
BOCA FL
33431-6469
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-5678
  • Fax:
Mailing address:
  • Phone: 305-467-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME111052
License Number StateFL

VIII. Authorized Official

Name: MR. JASON TOCCI
Title or Position: CEO
Credential:
Phone: 954-410-5194