Healthcare Provider Details

I. General information

NPI: 1992642128
Provider Name (Legal Business Name): INNOVATIVE PAIN & ORTHOPEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10305 NW 41ST ST STE 115
DORAL FL
33178-2975
US

IV. Provider business mailing address

1075 NE 125TH ST STE 102
NORTH MIAMI FL
33161-5800
US

V. Phone/Fax

Practice location:
  • Phone: 786-987-6269
  • Fax:
Mailing address:
  • Phone: 786-987-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EVELYN GAMAYO
Title or Position: OFFICE MANAGER
Credential:
Phone: 786-405-4777