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General NPI Number Information
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NPI Number | 1104285725
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Entity Type | Organization
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Legal Business Name | VITAL ORTHOPEDIC & SPINE INSTITUTE, INC
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 4848 COCONUT CREEK PKWY # 200
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3904
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Country | US
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Telephone | 877-848-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 S FEDERAL HWY # 199
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City | DELRAY BEACH
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State | FL
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Zip | 33483-3309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERE J MISSIRIAN
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Credential | MD
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Telephone | 877-848-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME114632
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License Number State | FL
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