Provider Demographics
NPI:1093517872
Name:BRAIN, SPINE AND PAIN INSTITUTE OF LAKE NONA PLLC
Entity type:Organization
Organization Name:BRAIN, SPINE AND PAIN INSTITUTE OF LAKE NONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:OCHIENG
Authorized Official - Last Name:MBEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-839-4889
Mailing Address - Street 1:13563 NARCOOSSEE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7138
Mailing Address - Country:US
Mailing Address - Phone:443-839-4889
Mailing Address - Fax:
Practice Address - Street 1:13563 NARCOOSSEE RD STE 110
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7138
Practice Address - Country:US
Practice Address - Phone:443-839-4889
Practice Address - Fax:407-887-1025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center