# SOUTH BAY REGENERATIVE MEDICAL SPA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Body Care Regenerative Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033733779
- **Authorized official:** MICHELLE VILLA (BILLING DEPT)
- **Authorized official phone:** (805) 474-9053

## Contact information

- **Practice address:** 412 S PACIFIC COAST HWY STE 100, REDONDO BEACH, CA 90277-3712
- **Practice address phone:** (310) 792-9100
- **Practice address fax:** (310) 792-1180
- **Mailing address:** 412 S PACIFIC COAST HWY STE 100, REDONDO BEACH, CA 90277-3712
- **Mailing address phone:** (310) 792-9100
- **Mailing address fax:** (310) 792-1180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/28/2020
- **Last updated:** 05/28/2020