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Organization
REGENTOX LLC
Active
Organization
REGENTOX LLC
Active
Other names
MB Laser Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
THERRESA ANHDAO NGOC QUACH (DIRECTOR)
(714) 465-9599
Entity
Organization
Contact information
Practice address
9191 BOLSA AVE STE 207, WESTMINSTER, CA 92683-5561
(714) 622-4125
(714) 622-4125
Mailing address
9191 BOLSA AVE STE 207, WESTMINSTER, CA 92683-5561
(714) 622-4125
(714) 622-4125
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AC6261
CA
174400000X
Specialist
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC0062610
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
04/04/2006
Last updated
10/27/2020
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