MEDICARE: REJUVENATION THERAPY LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1891501151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVENATION THERAPY LLC

Provider Business Mailing Address
First Line	:	5949 CASA CORONADO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3906
Country	:	US
Telephone Number	:	702-277-2778
Fax Number	:	702-946-1113

Provider Business Practice Location Address
First Line	:	5949 CASA CORONADO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3906
Country	:	US
Telephone Number	:	702-277-2778
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VIVIAN VILLIATORIA
Credential	:	NP
Telephone Number	:	702-277-2778

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	09/04/2025

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Directions to “REJUVENATION THERAPY LLC ” Practice Location

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