Provider Demographics
NPI:1851903223
Name:REGENERATE PRIMARY MEDICAL
Entity Type:Organization
Organization Name:REGENERATE PRIMARY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-1113
Mailing Address - Street 1:6161 SUNSET DR STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5045
Mailing Address - Country:US
Mailing Address - Phone:305-663-1113
Mailing Address - Fax:
Practice Address - Street 1:6161 SUNSET DR STE B
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5045
Practice Address - Country:US
Practice Address - Phone:305-663-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty