Healthcare Provider Details

I. General information

NPI: 1255282992
Provider Name (Legal Business Name): REGENIX MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 NE 15TH ST APT 35C
MIAMI FL
33132-1437
US

IV. Provider business mailing address

555 NE 15TH ST APT 35C
MIAMI FL
33132-1437
US

V. Phone/Fax

Practice location:
  • Phone: 954-562-2351
  • Fax:
Mailing address:
  • Phone: 954-562-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GAVIN AJAMI
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 954-562-2351