Healthcare Provider Details

I. General information

NPI: 1891508578
Provider Name (Legal Business Name): REGENERATIVE MEDICINE OF MAINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 DURHAM RD SUITE 301
FREEPORT ME
04032-6796
US

IV. Provider business mailing address

1461 TAGUS AVE
CORAL GABLES FL
33156-6405
US

V. Phone/Fax

Practice location:
  • Phone: 207-389-5009
  • Fax: 207-209-5089
Mailing address:
  • Phone: 786-247-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE LUIS MORA
Title or Position: PRESIDENT
Credential:
Phone: 786-247-2169