Healthcare Provider Details

I. General information

NPI: 1720992605
Provider Name (Legal Business Name): CENTRAL CARE SPINE ORTHOPEDIC & REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 SW 40TH ST STE 101
MIAMI FL
33155-5254
US

IV. Provider business mailing address

6085 SW 40TH ST STE 101
MIAMI FL
33155-5254
US

V. Phone/Fax

Practice location:
  • Phone: 305-433-4969
  • Fax: 305-432-4572
Mailing address:
  • Phone: 305-433-4969
  • Fax: 305-432-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARLOS LAZARO REYES
Title or Position: OWNER
Credential:
Phone: 305-433-4969