South Bay Regenerative Medical Spa Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

SOUTH BAY REGENERATIVE MEDICAL SPA INC

Doing business as

Body Care Regenerative Medicine

Practice address

412 S Pacific Coast Hwy Ste 100
Redondo Beach, CA 90277-3712

Phone

(310) 792-9100

Fax

(310) 792-1180

NPI assigned

May 28, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Villa

Title

Billing Dept

Phone

(805) 474-9053

Specialties & licenses 1

Addresses

Other names 1

• Body Care Regenerative Medicine Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sara A Rustin, DC

  • Chiropractor
  • Van Nuys, CA
  • NPI 1164663118
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1033733779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 S PACIFIC COAST HWY STE 100",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773712",
            "telephone_number": "310-792-9100",
            "fax_number": "310-792-1180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 S PACIFIC COAST HWY STE 100",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773712",
            "telephone_number": "310-792-9100",
            "fax_number": "310-792-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY REGENERATIVE MEDICAL SPA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-28",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "VILLA",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "BILLING DEPT",
        "authorized_official_telephone_number": "805-474-9053"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Body Care Regenerative Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Bay Children'S Health Center
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• South Bay Podiatry Office Inc
• Anna Southam, PT
• Southbay Galleria Optometric
• Spade Skin Care Medical Inc
• Speechcom Children'S Speech Therapy Center, Inc.
• Speechcom Incorporated

• General Practice Physician in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.