Provider Demographics
NPI:1891508578
Name:REGENERATIVE MEDICINE OF MAINE, LLC
Entity type:Organization
Organization Name:REGENERATIVE MEDICINE OF MAINE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-247-2169
Mailing Address - Street 1:1461 TAGUS AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6405
Mailing Address - Country:US
Mailing Address - Phone:786-247-2169
Mailing Address - Fax:
Practice Address - Street 1:23 DURHAM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6796
Practice Address - Country:US
Practice Address - Phone:207-389-5009
Practice Address - Fax:207-209-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty