Healthcare Provider Details

I. General information

NPI: 1013377191
Provider Name (Legal Business Name): SOUTH FLORIDA SPINE & SPORTS SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SW 148TH AVE SUITE 115
MIRAMAR FL
33027-4169
US

IV. Provider business mailing address

3000 SW 148TH AVE SUITE 115
MIRAMAR FL
33027-4181
US

V. Phone/Fax

Practice location:
  • Phone: 787-550-5625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO ROMERO
Title or Position: PARTNER
Credential:
Phone: 787-550-5625