Healthcare Provider Details

I. General information

NPI: 1932161007
Provider Name (Legal Business Name): REGENTOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 BOLSA AVE STE 207
WESTMINSTER CA
92683-5561
US

IV. Provider business mailing address

9191 BOLSA AVE STE 207
WESTMINSTER CA
92683-5561
US

V. Phone/Fax

Practice location:
  • Phone: 714-622-4125
  • Fax: 714-622-4125
Mailing address:
  • Phone: 714-622-4125
  • Fax: 714-622-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6261
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: THERRESA ANHDAO NGOC QUACH
Title or Position: DIRECTOR
Credential:
Phone: 714-465-9599