Provider Demographics
NPI:1659727840
Name:FLORIDA SPINE AND ORTHO CENTER CORP
Entity Type:Organization
Organization Name:FLORIDA SPINE AND ORTHO CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-250-8301
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-2638
Mailing Address - Country:US
Mailing Address - Phone:305-250-8301
Mailing Address - Fax:
Practice Address - Street 1:9370 SW 72ND ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5431
Practice Address - Country:US
Practice Address - Phone:305-250-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106368207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty