Provider Demographics
NPI:1801535349
Name:REGEN 40 LLC
Entity type:Organization
Organization Name:REGEN 40 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:NARCISO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:786-972-2643
Mailing Address - Street 1:8950 SW 74TH CT STE 2201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3181
Mailing Address - Country:US
Mailing Address - Phone:786-972-2643
Mailing Address - Fax:786-524-0509
Practice Address - Street 1:8950 SW 74TH CT STE 2201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3181
Practice Address - Country:US
Practice Address - Phone:786-972-2643
Practice Address - Fax:786-524-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty