Organization
LIFE REJUVENATED USA, LLC
Active
Other names
Life Rejuvenated
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SIMON MITTAL MD (PRESIDENT)
(507) 363-9367
Entity
Organization
Contact information
Practice address
1935 COUNTY ROAD B2 W STE 74, ROSEVILLE, MN 55113-2722
(800) 583-5290
Mailing address
1675 VILLAGE TRL E UNIT 6, MAPLEWOOD, MN 55109-5820
(507) 363-9367
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
06/04/2021
Last updated
06/04/2021
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