Healthcare Provider Details

I. General information

NPI: 1689248312
Provider Name (Legal Business Name): 2REJUV MD SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W DR MARTIN LUTHER KING JR BLVD STE 202
TAMPA FL
33603-3338
US

IV. Provider business mailing address

812 W DR MARTIN LUTHER KING JR BLVD STE 202
TAMPA FL
33603-3338
US

V. Phone/Fax

Practice location:
  • Phone: 877-627-3588
  • Fax:
Mailing address:
  • Phone: 877-627-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RONALD FIGUEREDO
Title or Position: OWNER
Credential:
Phone: 610-952-3430