Healthcare Provider Details

I. General information

NPI: 1225817117
Provider Name (Legal Business Name): WEST POMPANO SPINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W SAMPLE RD STE 4
POMPANO BEACH FL
33073-3035
US

IV. Provider business mailing address

2400 W SAMPLE RD STE 4
POMPANO BEACH FL
33073-3035
US

V. Phone/Fax

Practice location:
  • Phone: 954-636-1922
  • Fax: 954-636-1925
Mailing address:
  • Phone: 561-806-8306
  • Fax: 954-580-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REGIANE GOELZ
Title or Position: OWNER
Credential:
Phone: 561-806-8306