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General NPI Number Information
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NPI Number | 1376005009
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Entity Type | Organization
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Legal Business Name | REJUVENATION CARE CLINIC OF CENTRAL FLORIDA
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 2541 S VOLUSIA AVE STE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-9116
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Country | US
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Telephone | 800-641-9128
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Fax |
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Provider Business Mailing Address
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Address Line | 12221 E COLONIAL DR APT 1105
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City | ORLANDO
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State | FL
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Zip | 32826-4762
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Country | US
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Telephone | 800-641-9128
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CLAXTON COPELAND III
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Credential |
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Telephone | 800-641-9128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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