MEDICARE: REJUVENATION NEW LIFE TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	207LA0401X	Addiction Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1134069842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVENATION NEW LIFE TREATMENT CENTER

Provider Business Mailing Address
First Line	:	16731 BEECHNUT ST APT 1210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6647
Country	:	US
Telephone Number	:	346-318-5157
Fax Number	:

Provider Business Practice Location Address
First Line	:	16731 BEECHNUT ST APT 1210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-6647
Country	:	US
Telephone Number	:	346-318-5157
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YETUNDE M OGUNNIYI
Credential	:
Telephone Number	:	346-318-5157

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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