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General NPI Number Information
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NPI Number | 1205415882
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Entity Type | Organization
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Legal Business Name | REGENERATE GHODS, INC
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 6310 SAN VICENTE BLVD STE 220
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City | LOS ANGELES
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State | CA
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Zip | 90048-5458
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Country | US
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Telephone | 323-438-2650
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 WILSHIRE BLVD STE 208
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2328
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Country | US
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Telephone | 323-438-2650
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL FARAH
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Credential |
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Telephone | 310-879-7167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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