Provider Demographics
NPI:1588960553
Name:REJUVENEX MEDICAL CLINIC CORP.
Entity type:Organization
Organization Name:REJUVENEX MEDICAL CLINIC CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:I
Authorized Official - Credentials:OWNER
Authorized Official - Phone:786-468-5415
Mailing Address - Street 1:5200 SW 8TH ST
Mailing Address - Street 2:SUITE#150
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2300
Mailing Address - Country:US
Mailing Address - Phone:786-468-5415
Mailing Address - Fax:786-468-5414
Practice Address - Street 1:5200 SW 8TH ST
Practice Address - Street 2:SUITE#150
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2300
Practice Address - Country:US
Practice Address - Phone:786-468-5415
Practice Address - Fax:786-468-5414
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REJUVENEX MEDICAL CLINIC CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty