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General NPI Number Information
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NPI Number | 1568025419
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Entity Type | Organization
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Legal Business Name | REINVENTME, LLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 13696 N US HIGHWAY 441 STE 100
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City | LADY LAKE
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State | FL
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Zip | 32159-6815
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Country | US
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Telephone | 352-565-7633
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 SANTA BARBARA BLVD
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City | THE VILLAGES
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State | FL
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Zip | 32159-6827
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Country | US
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Telephone | 352-565-7633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRISHA KHANNA
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Credential |
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Telephone | 352-565-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery 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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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