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General NPI Number Information
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NPI Number | 1649734401
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Entity Type | Organization
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Legal Business Name | REGENESTHETICS
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 9700 N 91ST ST STE A115
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5036
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Country | US
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Telephone | 505-870-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 E OLIVE CT
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City | GILBERT
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State | AZ
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Zip | 85234-8162
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM BOZEMAN
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Credential |
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Telephone | 505-870-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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