Organization
REJUVENATION CARE CLINIC OF CENTRAL FLORIDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLAXTON COPELAND III (PRESIDENT)
(800) 641-9128
Entity
Organization
Contact information
Practice address
2541 S VOLUSIA AVE STE 100, ORANGE CITY, FL 32763-9116
(800) 641-9128
Mailing address
12221 E COLONIAL DR APT 1105, ORLANDO, FL 32826-4762
(800) 641-9128
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L19000063350
STATE LICENSE NUMBER
FL
Enumeration date
04/02/2019
Last updated
11/15/2024
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