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General NPI Number Information
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NPI Number | 1801535349
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Entity Type | Organization
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Legal Business Name | REGEN 40 LLC
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 8950 SW 74TH CT STE 2201
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City | MIAMI
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State | FL
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Zip | 33156-3181
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Country | US
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Telephone | 786-972-2643
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Fax | 786-524-0509
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Provider Business Mailing Address
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Address Line | 8950 SW 74TH CT STE 2201
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City | MIAMI
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State | FL
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Zip | 33156-3181
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Country | US
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Telephone | 786-972-2643
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Fax | 786-524-0509
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LUIS A NARCISO SR.
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Credential |
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Telephone | 786-972-2643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) 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 | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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