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General NPI Number Information
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NPI Number | 1912795709
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Entity Type | Organization
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Legal Business Name | RAZA NEUROSPINE, PLLC.
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 908 SW 113TH WAY
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-3710
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Country | US
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Telephone | 989-327-4408
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Fax |
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Provider Business Mailing Address
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Address Line | 908 SW 113TH WAY
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-3710
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Country | US
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Telephone | 989-327-4408
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. DIYAN MOHAMMAD RAZA
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Credential | MD
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Telephone | 989-327-4408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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