NPI 1023428521
Pacific Rejuvenation Medical, a Professional Corp.
Practice location
- Address
- 6310 San Vicente Blvd Suite 220, Los Angeles, CA 90048-5426
- Phone
- (818) 518-5980
- Fax
- (818) 337-2049
- Mailing address
- 2980 N Beverly Glen Cir Suite 100, Los Angeles, CA 90077-1726
Authorised official
- Name
- Lynn J. Goodloe
- Title
- Medical Director
- Phone
- (818) 518-5980
Registered specialties
Non-Pharmacy Dispensing Site
Primary
Registry record
- NPI
- 1023428521
- Entity type
- Organization
- NPI issued
- 6 May 2014
- Record last updated
- 5 Oct 2015
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.