Healthcare Provider Details

I. General information

NPI: 1528805207
Provider Name (Legal Business Name): REGEN HEALTH CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7990 SW 117TH AVE STE 205
MIAMI FL
33183-4865
US

IV. Provider business mailing address

7990 SW 117TH AVE STE 205
MIAMI FL
33183-4865
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-7447
  • Fax:
Mailing address:
  • Phone: 305-271-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AIXA GOODRICH
Title or Position: PRESIDENT
Credential: DC, RN
Phone: 305-310-1433