Provider Demographics
NPI:1134982028
Name:REGENERATIVE MEDICAL CLINICS OF SO CAL INC.
Entity type:Organization
Organization Name:REGENERATIVE MEDICAL CLINICS OF SO CAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN,DC, FNP
Authorized Official - Phone:626-965-2334
Mailing Address - Street 1:2361 S AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1537
Mailing Address - Country:US
Mailing Address - Phone:626-965-2334
Mailing Address - Fax:
Practice Address - Street 1:2361 S AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1537
Practice Address - Country:US
Practice Address - Phone:626-965-2334
Practice Address - Fax:626-964-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service