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General NPI Number Information
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NPI Number | 1083375307
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Entity Type | Organization
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Legal Business Name | REGEN ADVANCED INFUSION AND WELLNESS
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Dates
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Enumeration Date | 01/08/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 14067 W CYPRESS ST
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City | GOODYEAR
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State | AZ
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Zip | 85395-5703
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Country | US
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Telephone | 602-380-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 14067 W CYPRESS ST
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City | GOODYEAR
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State | AZ
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Zip | 85395-5703
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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 | PARTNER
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Name | BRUCE DANIEL BISHOP
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Credential | MD
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Telephone | 480-341-5174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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