Basic Information
| Provider Information | |||||||||
| NPI: | 1497483028 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CERTIFIED SPINE AND PAIN CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3335 BURNS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615784582 | ||||||||
| FaxNumber: | 5614324843 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 CONGRESS PARK DR STE 160 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334454724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615784582 | ||||||||
| FaxNumber: | 5614324843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2022 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | GUADAGNINO | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | MASELLI | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5615374526 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.