Organization Name: | REGENESIS LLC |
NPI Number: | 1366831554 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID LEMAY (PRESIDENT) |
Mailing Address: | 4960 Highway 90 Ste 115 Pace |
State: | FL US |
Postal Code: | 325711413 |
Phone Number: | 8508890711 |
Fax Number: | 8508075059 |
NPI Enumeration Date: | 01/12/2015 |
NPI Last Update Date: | 01/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9108469 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |