Provider Demographics
NPI:1366458978
Name:REGENETICS HEALTH INSTITUTE, PA
Entity Type:Organization
Organization Name:REGENETICS HEALTH INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:PLACER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-933-4441
Mailing Address - Street 1:8815 CONROY WINDERMERE RD
Mailing Address - Street 2:#203
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3129
Mailing Address - Country:US
Mailing Address - Phone:407-483-4079
Mailing Address - Fax:407-572-8642
Practice Address - Street 1:988 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1615
Practice Address - Country:US
Practice Address - Phone:407-483-4079
Practice Address - Fax:407-572-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82389208100000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2940027OtherAETNA
FL2940027OtherAETNA
311018616OtherTRICARE
FL5053308OtherCIGNA
111601OtherAMERIGROUP
03009OtherBCBS
FL261952100Medicaid
=========OtherCIGNA
311018616OtherTRICARE
FL2940027OtherAETNA
03009WMedicare ID - Type Unspecified
111601OtherAMERIGROUP
03009OtherBCBS
=========OtherUHC
H44611Medicare UPIN