Provider Demographics
NPI:1104369719
Name:CERTIFIED SPINE AND PAIN CARE
Entity Type:Organization
Organization Name:CERTIFIED SPINE AND PAIN CARE
Other - Org Name:DR. EDWIN W. MALDONADO, MD, PL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-578-4582
Mailing Address - Street 1:1049 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6135
Mailing Address - Country:US
Mailing Address - Phone:561-578-4582
Mailing Address - Fax:
Practice Address - Street 1:190 CONGRESS PARK DR
Practice Address - Street 2:SUITE 160
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4706
Practice Address - Country:US
Practice Address - Phone:561-578-4582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92323208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty