Regenerative Medicine Space Coast LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

REGENERATIVE MEDICINE SPACE COAST LLC

Practice address

954 Lake Baldwin LN
Orlando, FL 32814-6651

Phone

(407) 315-2271

NPI assigned

Feb 12, 2024

Organization subpart

No

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

Authorized official

Name

Rafael Foss, DC

Title

Owner

Phone

(786) 370-1111

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1760246656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24556",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322414556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "954 LAKE BALDWIN LN",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328146651",
            "telephone_number": "407-315-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENERATIVE MEDICINE SPACE COAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-10",
        "status": "A",
        "authorized_official_last_name": "FOSS",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-370-1111",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Orlando, FL
• Providers in Orlando, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.