Provider Demographics
NPI:1881838845
Name:SAN FRANCISCO REJUVENATION CENTER, LLC
Entity Type:Organization
Organization Name:SAN FRANCISCO REJUVENATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-567-7170
Mailing Address - Street 1:2402 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1809
Mailing Address - Country:US
Mailing Address - Phone:415-567-7170
Mailing Address - Fax:
Practice Address - Street 1:2402 CLAY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1809
Practice Address - Country:US
Practice Address - Phone:415-567-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical