| Regeneration Psychiatry | |
|
2512 Artesia Blvd Ste 310 Redondo Beach CA 90278-3274 | |
| (424) 277-2899 | |
| (424) 277-2899 |
| Full Name | Regeneration Psychiatry |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2512 Artesia Blvd Ste 310, Redondo Beach, California |
| Authorized Official Name and Position | Jobert Ballesteros Poblete (COO/SECRETARY) |
| Authorized Official Contact | 4242772899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regeneration Psychiatry 2512 Artesia Blvd Ste 310 Redondo Beach CA 90278-3274 Ph: (424) 277-2899 | Regeneration Psychiatry 2512 Artesia Blvd Ste 310 Redondo Beach CA 90278-3274 Ph: (424) 277-2899 |
| NPI Number | 1285200584 |
|---|---|
| Provider Enumeration Date | 05/28/2021 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 3072911122 |
|---|---|
| Medicare Enrollment ID | O20211005000739 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285200584 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jobert B Poblete |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063944759 PECOS PAC ID: 4880925288 Enrollment ID: I20191121001917 |
| Provider Name | Wenqi Feng |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861933103 PECOS PAC ID: 9638409444 Enrollment ID: I20191212000906 |
| Provider Name | Justin C Key |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093246647 PECOS PAC ID: 0244560480 Enrollment ID: I20210415002842 |
| Provider Name | Brittany Lee Tarrant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073017570 PECOS PAC ID: 9133550718 Enrollment ID: I20220810001911 |
| Provider Name | Stephanie Ann Sabra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295266104 PECOS PAC ID: 6800272881 Enrollment ID: I20220928001232 |
| Provider Name | Arjun Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346732450 PECOS PAC ID: 6002153103 Enrollment ID: I20231002001566 |
| Provider Name | Tashalee Rushell Brown |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699260703 PECOS PAC ID: 5890165351 Enrollment ID: I20240326002837 |
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