=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740075274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REJUVERA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7601 RIALTO BLVD APT 1826
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78735-7426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-334-2721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7601 RIALTO BLVD APT 1826
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78735-7426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-334-2721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS TAKWA ELSAYYAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-334-2721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------