Healthcare Provider Details

I. General information

NPI: 1295316743
Provider Name (Legal Business Name): REJUVENATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 GUNN HWY
TAMPA FL
33625-4022
US

IV. Provider business mailing address

6516 GUNN HWY
TAMPA FL
33625-4022
US

V. Phone/Fax

Practice location:
  • Phone: 813-305-0436
  • Fax:
Mailing address:
  • Phone: 813-800-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: HANI RAYESS
Title or Position: OWNER
Credential: M.D.
Phone: 949-302-0363