MEDICARE: CERTIFIED SPINE AND PAIN CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician		FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982128666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED SPINE AND PAIN CARE

Provider Business Mailing Address
First Line	:	1049 S STATE ROAD 7
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 BURNS RD STE 300
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4311
Country	:	US
Telephone Number	:	561-537-4526
Fax Number	:	561-432-4843

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	JORGE GARCIA
Credential	:
Telephone Number	:	561-578-4582

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	02/14/2023

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Directions to “CERTIFIED SPINE AND PAIN CARE ” Practice Location

Language	Start Address	Practice Location

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