Healthcare Provider Details

I. General information

NPI: 1518793017
Provider Name (Legal Business Name): MIAMI SPINE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 IVES DAIRY RD STE 105
MIAMI FL
33179-2536
US

IV. Provider business mailing address

1011 IVES DAIRY RD STE 105
MIAMI FL
33179-2536
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-4603
  • Fax:
Mailing address:
  • Phone: 305-705-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA GOMEZ
Title or Position: OWNER
Credential: DC
Phone: 305-705-4603