Healthcare Provider Details

I. General information

NPI: 1972273597
Provider Name (Legal Business Name): REGENERATIVE MEDICAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 303
BEVERLY HILLS CA
90211-2283
US

IV. Provider business mailing address

99 N LA CIENEGA BLVD STE 303
BEVERLY HILLS CA
90211-2283
US

V. Phone/Fax

Practice location:
  • Phone: 757-373-8438
  • Fax:
Mailing address:
  • Phone: 757-373-8438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL LEIBOVICI
Title or Position: OWNER
Credential: MD
Phone: 757-373-8438