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General NPI Number Information
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NPI Number | 1225902349
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Entity Type | Organization
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Legal Business Name | REGENERATIVE WOUND SOLUTIONS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 2208 W WHITTIER BLVD STE C
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City | LA HABRA
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State | CA
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Zip | 90631-3403
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Country | US
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Telephone | 562-329-8647
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 W WHITTIER BLVD STE C
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City | LA HABRA
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State | CA
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Zip | 90631-3403
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Country | US
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Telephone | 562-329-8647
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEITH CARRILLO
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Credential |
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Telephone | 562-652-0923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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