Organization
REGENERATIVE MEDICINE SPACE COAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL FOSS DC (OWNER)
(786) 370-1111
Entity
Organization
Contact information
Practice address
3800 W EAU GALLIE BLVD STE 101, MELBOURNE, FL 32934-3285
(321) 323-3618
Mailing address
PO BOX 24556, JACKSONVILLE, FL 32241-4556
(786) 370-1111
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
06/22/2020
Last updated
02/10/2024
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