Provider Demographics
NPI:1598024580
Name:INFINITE REJUVENATION LLC
Entity Type:Organization
Organization Name:INFINITE REJUVENATION LLC
Other - Org Name:INFINITE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIARRIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:803-547-4343
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:1698 HIGHWAY 160 W
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8032
Practice Address - Country:US
Practice Address - Phone:803-547-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFINITE REJUVENATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-10
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site