Provider Demographics
NPI:1952866675
Name:REGENERATIVE MEDICAL CENTER MANAGEMENT LLC
Entity Type:Organization
Organization Name:REGENERATIVE MEDICAL CENTER MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-702-2500
Mailing Address - Street 1:4310 TRADEWINDS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1410
Mailing Address - Country:US
Mailing Address - Phone:805-702-2500
Mailing Address - Fax:805-233-3035
Practice Address - Street 1:4310 TRADEWINDS DR STE 300
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1410
Practice Address - Country:US
Practice Address - Phone:805-702-2500
Practice Address - Fax:805-233-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center