Provider Demographics
NPI:1023378981
Name:REGENERATIVE OPTIMUM HEALTH INC
Entity Type:Organization
Organization Name:REGENERATIVE OPTIMUM HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LLORENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-885-8980
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:SUITE 257
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-885-8980
Mailing Address - Fax:714-434-0790
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:SUITE 257
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-885-8980
Practice Address - Fax:714-434-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty