Provider Demographics
NPI:1568960904
Name:THRIVE REJUVENATION INC
Entity Type:Organization
Organization Name:THRIVE REJUVENATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YONATAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:949-430-2828
Mailing Address - Street 1:355 PLACENTIA AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3303
Mailing Address - Country:US
Mailing Address - Phone:949-430-2828
Mailing Address - Fax:
Practice Address - Street 1:355 PLACENTIA AVE STE 307
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3303
Practice Address - Country:US
Practice Address - Phone:949-430-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy