MEDICARE: ADVANCED REGENERATION THERAPY MEDICAL GROUP, INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1932536372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED REGENERATION THERAPY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	PO BOX 91023
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91109-1023
Country	:	US
Telephone Number	:	818-397-5407
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N PACIFIC COAST HWY STE 1111
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2167
Country	:	US
Telephone Number	:	310-374-4278
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/MEDICAL DIRECTOR
Name	:	DR. ROSELINE M DAUPHIN BAPTISTE
Credential	:	M.D.
Telephone Number	:	818-397-5407

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	09/30/2013

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