MEDICARE: REJUVENATE MIAMI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1538945175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVENATE MIAMI LLC

Provider Business Mailing Address
First Line	:	1430 MADRUGA AVE # 29
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3178
Country	:	US
Telephone Number	:	786-904-5552
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	1430 MADRUGA AVE # 29
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3178
Country	:	US
Telephone Number	:	786-904-5552
Fax Number	:	--

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CHELSEA ALMAZAN
Credential	:	RN
Telephone Number	:	305-905-8273

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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