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Organization
AGE REJUVENATION MEDICAL, P.A.
Active
Organization
AGE REJUVENATION MEDICAL, P.A.
Active
Other names
Age Rejuvenation
Organization subpart
No
Provider details
NPI number
Authorized official
YAZMYNE MIRANDA (COO)
(954) 682-3015
Entity
Organization
Contact information
Practice address
125 N ORLANDO AVE STE 115, WINTER PARK, FL 32789-3605
(407) 565-5929
Mailing address
2409 N FALKENBURG RD, TAMPA, FL 33619-0915
Taxonomy
Speciality
Code
Description
License number
State
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
NULL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
NULL
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
NULL
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
Other
Enumeration date
12/13/2024
Last updated
01/20/2025
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