Healthcare Provider Details

I. General information

NPI: 1750117214
Provider Name (Legal Business Name): REGENERATIVE IMMUNOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST STE 314
BERKELEY CA
94705-1976
US

IV. Provider business mailing address

2320 WOOLSEY ST STE 314
BERKELEY CA
94705-1976
US

V. Phone/Fax

Practice location:
  • Phone: 510-616-8688
  • Fax: 510-666-0916
Mailing address:
  • Phone: 510-616-8688
  • Fax: 510-666-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: NATALIYA KUSHNIR
Title or Position: CEO
Credential: MD
Phone: 510-616-8688