Provider Demographics
NPI:1275189342
Name:THE OSTEO REGENERATIVE CLINIC OF SOUTH FLORIDA, LLC
Entity Type:Organization
Organization Name:THE OSTEO REGENERATIVE CLINIC OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, ARNP, FNP-BC
Authorized Official - Phone:786-579-0900
Mailing Address - Street 1:7775 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2536
Mailing Address - Country:US
Mailing Address - Phone:786-579-0900
Mailing Address - Fax:773-249-6662
Practice Address - Street 1:7775 SW 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2536
Practice Address - Country:US
Practice Address - Phone:786-579-0900
Practice Address - Fax:773-249-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty