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General NPI Number Information
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NPI Number | 1891501151
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Entity Type | Organization
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Legal Business Name | REJUVENATION THERAPY LLC
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 5949 CASA CORONADO AVE
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City | LAS VEGAS
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State | NV
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Zip | 89131-3906
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Country | US
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Telephone | 702-277-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 5949 CASA CORONADO AVE
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City | LAS VEGAS
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State | NV
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Zip | 89131-3906
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Country | US
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Telephone | 702-277-2778
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Fax | 702-946-1113
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Authorized Official
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Title or Position | OWNER
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Name | VIVIAN VILLIATORIA
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Credential | NP
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Telephone | 702-277-2778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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