Healthcare Provider Details

I. General information

NPI: 1609706613
Provider Name (Legal Business Name): REGEN MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE MEDICA SAN FERNANDO OFICINA 503 CALLE AMADEO ESQUINA AVE FERNADEZ JUNCOS
CAROLINA PR
00986
US

IV. Provider business mailing address

PO BOX 1792
CAROLINA PR
00984-1792
US

V. Phone/Fax

Practice location:
  • Phone: 787-274-2900
  • Fax:
Mailing address:
  • Phone: 787-274-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSUE GONZALEZ RIVERA
Title or Position: CEO
Credential:
Phone: 787-941-8785