Healthcare Provider Details

I. General information

NPI: 1801535349
Provider Name (Legal Business Name): REGEN 40 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 SW 74TH CT STE 2201
MIAMI FL
33156-3181
US

IV. Provider business mailing address

8950 SW 74TH CT STE 2201
MIAMI FL
33156-3181
US

V. Phone/Fax

Practice location:
  • Phone: 786-972-2643
  • Fax: 786-524-0509
Mailing address:
  • Phone: 786-972-2643
  • Fax: 786-524-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS A NARCISO SR.
Title or Position: PRESIDENT
Credential:
Phone: 786-972-2643