Organization
REJUVA MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH ANDRONICO D.O. (OWNER)
(813) 907-0950
Entity
Organization
Contact information
Practice address
28945 STATE ROAD 54, SUITE 101, WESLEY CHAPEL, FL 33543
(813) 907-0950
(813) 907-7949
Mailing address
28945 STATE ROAD 54, SUITE 101, WESLEY CHAPEL, FL 33543
(813) 907-0950
(813) 907-7949
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OS004967
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013795600
—
FL
Enumeration date
12/02/2015
Last updated
12/02/2015
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