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General NPI Number Information
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NPI Number | 1013448786
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Entity Type | Organization
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Legal Business Name | REJUVINIX JOINT AND SPORTS CLINIC
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 4701 COLUMBUS ST SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6725
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Country | US
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Telephone | 414-736-1317
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Fax |
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Provider Business Mailing Address
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Address Line | 575 LYNNHAVEN PKWY SUITE 200
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-7350
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RICHARD SALINAS
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Credential | RN
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Telephone | 414-736-1317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 0101052872
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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