Provider Demographics
NPI:1063078293
Name:REGENERATIVE HEALTH AND WELLNESS INSTITUTE
Entity type:Organization
Organization Name:REGENERATIVE HEALTH AND WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-435-0404
Mailing Address - Street 1:17412 VENTURA BLVD # 344
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3827
Mailing Address - Country:US
Mailing Address - Phone:310-982-6026
Mailing Address - Fax:
Practice Address - Street 1:4207 DEL REY AVE
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5605
Practice Address - Country:US
Practice Address - Phone:310-982-6026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain