Provider Demographics
NPI:1629626981
Name:REJUVENATE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:REJUVENATE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JESIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-295-9791
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA STE 404
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3120
Mailing Address - Country:US
Mailing Address - Phone:619-295-9791
Mailing Address - Fax:619-297-6901
Practice Address - Street 1:5030 CAMINO DE LA SIESTA STE 404
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3120
Practice Address - Country:US
Practice Address - Phone:619-295-9791
Practice Address - Fax:619-297-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty