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General NPI Number Information
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NPI Number | 1134069842
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Entity Type | Organization
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Legal Business Name | REJUVENATION NEW LIFE TREATMENT CENTER
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 16731 BEECHNUT ST APT 1210
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City | HOUSTON
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State | TX
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Zip | 77083-6647
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Country | US
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Telephone | 346-318-5157
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Fax |
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Provider Business Mailing Address
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Address Line | 16731 BEECHNUT ST APT 1210
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City | HOUSTON
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State | TX
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Zip | 77083-6647
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Country | US
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Telephone | 346-318-5157
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YETUNDE M OGUNNIYI
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Credential |
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Telephone | 346-318-5157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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