Organization
REGEN PRIMARY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYN HENDERSON (OWNER)
(714) 551-9576
Entity
Organization
Contact information
Practice address
8390 CHAMPIONS GATE BLVD STE 108, CHAMPIONS GATE, FL 33896-8311
(714) 551-9576
Mailing address
8390 CHAMPIONS GATE BLVD STE 108, CHAMPIONS GATE, FL 33896-8311
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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