# PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP

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

## Provider details

- **NPI number:** 1528348620
- **Authorized official:** GLEN FARKAS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (818) 610-9360

## Contact information

- **Practice address:** 7230 MEDICAL CENTER DRIVE, SUITE 302, WEST HILLS, CA 91307
- **Practice address phone:** (818) 518-5980
- **Practice address fax:** (818) 337-2049
- **Mailing address:** 7230 MEDICAL CENTER DRIVE, SUITE 302, WEST HILLS, CA 91307
- **Mailing address phone:** (818) 518-5980
- **Mailing address fax:** (818) 337-2049

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | PSY22296 | CA | — |
| 111NN1001X | Nutrition Chiropractor | DC24805 | CA | — |
| 171100000X | Acupuncturist | AC8403 | CA | — |
| 208D00000X | General Practice Physician | G56249 | CA | Yes |
| 363A00000X | Physician Assistant | PA17921 | CA | — |

## Other

- **Enumeration date:** 08/19/2011
- **Last updated:** 08/19/2011