| Regenestem, Llc | |
|
9633 W Broward Blvd Ste 1 Plantation FL 33324-2332 | |
| (305) 224-1858 | |
| Not Available |
| Full Name | Regenestem, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9633 W Broward Blvd Ste 1, Plantation, Florida |
| Authorized Official Name and Position | Ricardo Decubas (PRESIDENT) |
| Authorized Official Contact | 3052241858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenestem, Llc 9633 W Broward Blvd Ste 1 Plantation FL 33324-2332 Ph: (305) 224-1858 | Regenestem, Llc 9633 W Broward Blvd Ste 1 Plantation FL 33324-2332 Ph: (305) 224-1858 |
| NPI Number | 1427696681 |
|---|---|
| Provider Enumeration Date | 12/18/2019 |
| Last Update Date | 01/29/2020 |
| Medicare PECOS PAC ID | 8628403219 |
|---|---|
| Medicare Enrollment ID | O20200108000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427696681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Humberto R Fernandez Miro |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1356436786 PECOS PAC ID: 9537071832 Enrollment ID: I20031105000008 |
| Provider Name | Stephen B Channey |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1316927825 PECOS PAC ID: 2365430246 Enrollment ID: I20040501000297 |
| Provider Name | Oelsner O Viera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861485450 PECOS PAC ID: 7113947037 Enrollment ID: I20100622000443 |
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