Provider Demographics
NPI:1437475076
Name:REJUVAMED LLC
Entity Type:Organization
Organization Name:REJUVAMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:LINGLE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:404-264-0800
Mailing Address - Street 1:3644 LLOYD PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6027
Mailing Address - Country:US
Mailing Address - Phone:404-264-0800
Mailing Address - Fax:
Practice Address - Street 1:3644 LLOYD PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6027
Practice Address - Country:US
Practice Address - Phone:404-264-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care