Healthcare Provider Details

I. General information

NPI: 1609229871
Provider Name (Legal Business Name): NEVADA SPINE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7315 HUDSON AVE
HUDSON FL
34667-1158
US

IV. Provider business mailing address

PO BOX 5519
HUDSON FL
34674-5519
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-9563
  • Fax: 727-861-2253
Mailing address:
  • Phone: 727-868-9563
  • Fax: 727-869-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MARCELO D. EGUINO
Title or Position: VP
Credential:
Phone: 727-868-9563