Healthcare Provider Details

I. General information

NPI: 1952866675
Provider Name (Legal Business Name): REGENERATIVE MEDICAL CENTER MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 TRADEWINDS DR STE 300
OXNARD CA
93035-1410
US

IV. Provider business mailing address

4310 TRADEWINDS DR STE 300
OXNARD CA
93035-1410
US

V. Phone/Fax

Practice location:
  • Phone: 805-702-2500
  • Fax: 805-233-3035
Mailing address:
  • Phone: 805-702-2500
  • Fax: 805-233-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN DAVID LAIRD
Title or Position: OWNER
Credential: DC
Phone: 805-702-2500