Provider Demographics
NPI:1235500166
Name:VENVIDIVICI LLC
Entity Type:Organization
Organization Name:VENVIDIVICI LLC
Other - Org Name:REGENERATIVE CENTER OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-962-4183
Mailing Address - Street 1:2620 CULLEN PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-9008
Mailing Address - Country:US
Mailing Address - Phone:281-520-1495
Mailing Address - Fax:281-412-4020
Practice Address - Street 1:2620 CULLEN PKWY STE 202
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-9008
Practice Address - Country:US
Practice Address - Phone:281-520-1495
Practice Address - Fax:281-412-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0081208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123806Medicare UPIN