PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP. (NPI# 1023428521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023428521 |
| Entity Type | Organization |
| Organization Name | PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP. |
| Practice Address |
6310 San Vicente Blvd Suite 220 Los Angeles CA 90048-5426 |
| Mailing Address |
2980 N Beverly Glen Cir Suite 100 Los Angeles CA 90077-1726 |
| Practice Telephone | 8185185980 |
| Practice Fax Number | 8183372049 |
| Mailing Telephone | 3109434180 |
| Mailing Fax Number | 8884318819 |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2015-10-05 |
| Authorized Official Name | DR. LYNN J. GOODLOE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8185185980 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | G44674 | CA | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831519156 | Pacific Rejuvenation Medical, A Professional Corp. | Non-Pharmacy Dispensing Site | 7230 Medical Center Dr, Suite 302, West Hills, CA 91307-1907 | 2014-04-25 |
| Street Address |
6310 SAN VICENTE BLVD SUITE 220 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90048-5426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184608002 | Sharo Raissi | Specialist | 6310 San Vicente Blvd, Ste 220, Los Angeles, CA 90048-5426 | 2005-12-05 |
| 1710437231 | San Vincente Women's Total Health Center Inc | Pharmacy | 6310 San Vicente Blvd, Suite 220, Los Angeles, CA 90048-5426 | 2016-10-07 |
| 1609279306 | Beverly Hills Allergy | Allergy & Immunology | 6310 San Vicente Blvd, 220, Los Angeles, CA 90048-5426 | 2014-10-08 |
| 1396145959 | Anna Milanesi Md Inc | Internal Medicine | 6310 San Vicente Blvd, 220, Los Angeles, CA 90048-5426 | 2014-09-01 |
| 1629477872 | Joy Chudzynski | Psychologist | 6310 San Vicente Blvd, #410, Los Angeles, CA 90048-5426 | 2014-08-13 |
| 1477963403 | Beverly Hills Institute of Gastroenterology | Specialist | 6310 San Vicente Blvd, Suite 220, Los Angeles, CA 90048-5426 | 2014-04-29 |
| 1396183778 | Women To Women Obgyn of Los Angeles | Specialist | 6310 San Vicente Blvd, Suite 330, Los Angeles, CA 90048-5426 | 2013-06-07 |
| 1780929265 | Sharo S Raissi Md PC | Specialist | 6310 San Vicente Blvd, Ste 220, Los Angeles, CA 90048-5426 | 2012-12-10 |
| 1982950291 | Kalina Benedict | Genetic Counselor, MS | 6310 San Vicente Blvd, Los Angeles, CA 90048-5426 | 2012-07-24 |
| 1851669741 | San Vicente Women's Total Health Center Inc | Specialist | 6310 San Vicente Blvd, Ste220, Los Angeles, CA 90048-5426 | 2011-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609473420 | Alden Advanced Surgicenter LLC | Clinic/Center | 8741 Alden Drive, Suite B, Los Angeles, CA 90048 | 2020-10-05 |
| 1760090062 | New Dawn Tms Psychiatry | Clinic/Center | 640 S San Vincente Blvd, Ste. 210, Los Angeles, CA 90048 | 2020-07-22 |
| 1114547312 | Savannah Marie Gonzales | Student in an Organized Health Care Education/Training Program | 8700 Beverly Blvd Suite 3636, Los Angeles, CA 90048 | 2020-04-17 |
| 1861048613 | Sam Dawkins | Internal Medicine | Suite 415e, 8631 West Third Street, Los Angeles, CA 90048 | 2019-08-16 |
| 1295202638 | Caleb Rogers Penn | Anesthesiology | Cedars-sinai Department of Anesthesiology, 8700 Beverly Blvd, Los Angeles, CA 90048 | 2018-10-24 |
| 1437641727 | Medical Imaging Center of Southern California-beverly Hills, Inc | Radiology | 8727 Beverly Blvd, Los Angeles, CA 90048 | 2018-06-01 |
| 1689164121 | Maulin Shah | Student in an Organized Health Care Education/Training Program | 8700 Beverly Blvd Suite 5512, Los Angeles, CA 90048 | 2018-05-10 |
| 1013423631 | Abdul Ali Qaderi | Anesthesiology | 8700 Beverly Blvd Suite 4209, Los Angeles, CA 90048 | 2017-12-19 |
| 1619483559 | Sakeenah Hakim | Social Worker | 292 S. La Cienega Blvd, Suite 102, Los Angeles, CA 90048 | 2017-12-14 |
| 1851805048 | West Hollywood Medical Group Inc | General Practice | 8733 Beverly Blvd Suite #203, West Hollywood, CA 90048 | 2017-11-27 |
| Find all providers in zip 90048 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| 1932395092 | Glenville Medical Group, A Medical Corporation | Non-Pharmacy Dispensing Site | 1531 Glenville Dr, Los Angeles, CA 90035-3107 | 2007-09-21 |
| 1265441216 | Randy L Peters | Non-Pharmacy Dispensing Site | 3198 W 7th St Apt 318, Los Angeles, CA 90005-1659 | 2006-08-07 |
| 1891245619 | Keith L. Gurnick, D.p.m. | Non-Pharmacy Dispensing Site | 2080 Century Park E, Suite 705, Los Angeles, CA 90067-2001 | 2016-10-04 |
| 1770962946 | R Roland Lopez, M.d., Inc. | Non-Pharmacy Dispensing Site | 1711 W Temple St, Suite 4100, Los Angeles, CA 90026-5421 | 2015-05-21 |
| 1386021475 | R Roland Lopez, M.d., Inc. | Non-Pharmacy Dispensing Site | 5301 Whittier Blvd, Suite B, Los Angeles, CA 90022-4038 | 2015-04-28 |
| 1033501101 | Ais Medical Foods, Inc. | Non-Pharmacy Dispensing Site | 8631 W 3rd St, Suite 1145e, Los Angeles, CA 90048-5901 | 2015-02-26 |
| 1255749099 | Morningside Primary Care Medical Center Mc Inc A Nevada Corporation | Non-Pharmacy Dispensing Site | 617 W Manchester Ave, Los Angeles, CA 90044-5718 | 2014-07-24 |
| 1386058402 | Arj Medical, Inc. | Non-Pharmacy Dispensing Site | 5655 E Beverly Blvd, Los Angeles, CA 90022-2803 | 2014-06-17 |
| 1043624489 | Daniel Capen, M.d., A Professional Corporation | Non-Pharmacy Dispensing Site | 6200 Wilshire Blvd, Suite 910, Los Angeles, CA 90048-5801 | 2014-06-13 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90048 |
Please comment or provide details below to improve the information on PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.