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General NPI Number Information
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NPI Number | 1093517872
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Entity Type | Organization
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Legal Business Name | BRAIN, SPINE AND PAIN INSTITUTE OF LAKE NONA PLLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 13563 NARCOOSSEE RD STE 110
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City | ORLANDO
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State | FL
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Zip | 32832-7138
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Country | US
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Telephone | 443-839-4889
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Fax | 407-887-1025
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Provider Business Mailing Address
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Address Line | 13563 NARCOOSSEE RD STE 110
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City | ORLANDO
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State | FL
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Zip | 32832-7138
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Country | US
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Telephone | 443-839-4889
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GILBERT OCHIENG MBEO
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Credential | MD
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Telephone | 443-839-4889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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