Healthcare Provider Details

I. General information

NPI: 1295317618
Provider Name (Legal Business Name): TOTAL REGENERATIVE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PARKS AVE STE 700
VIRGINIA BEACH VA
23451-4160
US

IV. Provider business mailing address

2101 PARKS AVE STE 700
VIRGINIA BEACH VA
23451-4160
US

V. Phone/Fax

Practice location:
  • Phone: 818-424-4270
  • Fax:
Mailing address:
  • Phone: 818-424-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: TONYA GILLIAM
Title or Position: DIRECTOR OF BILLING AND COMPLIANCE
Credential:
Phone: 972-632-6877