Organization
PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.
Active
Parent organization
PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.
Organization subpart
Yes
Provider details
NPI number
Legal business name
PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.
Authorized official
DR. LYNN J. GOODLOE M.D. (MEDICAL DIRECTOR)
(818) 518-5980
Entity
Organization
Contact information
Practice address
6310 SAN VICENTE BLVD, SUITE 220, LOS ANGELES, CA 90048-5426
(818) 518-5980
(818) 337-2049
Mailing address
2980 N BEVERLY GLEN CIR, SUITE 100, LOS ANGELES, CA 90077-1726
(310) 943-4180
(888) 431-8819
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G44674
CA
Other
Enumeration date
05/06/2014
Last updated
10/05/2015
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