# REJUVENATION CARE CLINIC OF CENTRAL FLORIDA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376005009
- **Authorized official:** MR. CLAXTON COPELAND III (PRESIDENT)
- **Authorized official phone:** (800) 641-9128

## Contact information

- **Practice address:** 2541 S VOLUSIA AVE STE 100, ORANGE CITY, FL 32763-9116
- **Practice address phone:** (800) 641-9128
- **Mailing address:** 12221 E COLONIAL DR APT 1105, ORLANDO, FL 32826-4762
- **Mailing address phone:** (800) 641-9128

## Taxonomy

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

## Other

- **Enumeration date:** 04/02/2019
- **Last updated:** 11/15/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | L19000063350 | STATE LICENSE NUMBER | FL |