Healthcare Provider Details

I. General information

NPI: 1013328277
Provider Name (Legal Business Name): REGENERATIVE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E CHAPMAN AVE
ORANGE CA
92866-1643
US

IV. Provider business mailing address

615 E CHAPMAN AVE
ORANGE CA
92866-1643
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4012
  • Fax: 714-639-4018
Mailing address:
  • Phone: 714-639-4012
  • Fax: 714-639-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYN J HENDERSON
Title or Position: DIRECTOR
Credential: MD
Phone: 714-981-8058