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NPI Code Detail

MEDICARE: REJUVV, P.C.

MEDICARE: REJUVV, P.C.
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1992452551
Entity Type Code : Organization
Provider Name (Legal Business Name) : REJUVV, P.C.
Provider Business Mailing Address
First Line : 18119 PRAIRIE AVE
Second Line :
City : TORRANCE
State : CA
Zip : 90504-3739
Country : US
Telephone Number : 310-980-8368
Fax Number :
Provider Business Practice Location Address
First Line : 1101 N SEPULVEDA BLVD STE 202
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-5963
Country : US
Telephone Number : 310-980-8368
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MARTHA KOO
Credential : M.D.
Telephone Number : 310-980-8368
Provider Enumeration Date : 03/03/2022
Last Update Date : 03/03/2022

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