Healthcare Provider Details

I. General information

NPI: 1164279972
Provider Name (Legal Business Name): REJUVEN HEALTH LV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 W LAKE MEAD PKWY STE 8
HENDERSON NV
89015-7055
US

IV. Provider business mailing address

1906 THUNDER RIDGE CIR
HENDERSON NV
89012-2206
US

V. Phone/Fax

Practice location:
  • Phone: 725-264-8686
  • Fax: 877-409-1697
Mailing address:
  • Phone: 405-881-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LENA NGUYEN
Title or Position: CEO
Credential: APRN
Phone: 405-881-6822