Pacific Rejuvenation Medical, a Professional Corp.
NPI #1023428521 in Los Angeles, California
Provider Information
- NPI Number
- 1023428521
- Entity Type
- Organization
- Organization Name
- Pacific Rejuvenation Medical, a Professional Corp.
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.
- Primary Specialty
- Non-Pharmacy Dispensing Site
- Enumeration Date
- May 6, 2014
- Last Updated
- Oct 5, 2015
Practice Location
- Address
- 6310 SAN VICENTE BLVD
- Address 2
- SUITE 220
- City
- Los Angeles
- State
- California
- ZIP Code
- 90048-5426
- Phone
- (818) 518-5980
Authorized Official
- Name
- DR. LYNN J. GOODLOE, M.D.
- Title
- MEDICAL DIRECTOR
- Phone
- (818) 518-5980
Specialties & Taxonomy Codes
| Specialty |
|---|
| Non-Pharmacy Dispensing Site |
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