# AGE REJUVENATION MEDICAL, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Age Rejuvenation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801603717
- **Authorized official:** YAZMYNE MIRANDA (COO)
- **Authorized official phone:** (954) 682-3015

## Contact information

- **Practice address:** 125 N ORLANDO AVE STE 115, WINTER PARK, FL 32789-3605
- **Practice address phone:** (407) 565-5929
- **Mailing address:** 2409 N FALKENBURG RD, TAMPA, FL 33619-0915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | NULL | — |
| 133VN1201X | Obesity and Weight Management Nutrition Registered Dietitian | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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