Provider Demographics
NPI:1528678489
Name:ADVANCED REGENERATIVE HEALING AND WELLNESS CENTER
Entity type:Organization
Organization Name:ADVANCED REGENERATIVE HEALING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, CHIEF HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-260-7234
Mailing Address - Street 1:44257 MEADOW GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544
Mailing Address - Country:US
Mailing Address - Phone:951-260-7234
Mailing Address - Fax:
Practice Address - Street 1:26440 LA ALAMEDA
Practice Address - Street 2:SUITE 380
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-446-9272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center