NPIMap

Organization Active NPI

Pacific Rejuvenation Medical, a Professional Corp.

  • Non-Pharmacy Dispensing Site
  • West Hills, CA
National Provider Identifier
1831519156
Registry record updated Oct 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
G56249 Issued in CA
Legal business name
PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.
Practice address
7230 Medical Center Dr
Suite 302
West Hills, CA 91307-1907
Phone
(818) 518-5980
NPI assigned
Apr 25, 2014
Organization subpart
Yes
Parent organization
PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2015

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

Authorized official

Name
Dr. Glen C. Farkas, M.D.
Title
Medical Director
Phone
(818) 518-5980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X G56249 CA Primary

Addresses

Primary practice location

7230 Medical Center Dr
Suite 302
West Hills, CA 91307-1907

Mailing address

2980 N Beverly Glen Cir
Suite 100
Los Angeles, CA 90077-1726
Phone (310) 943-4180

National Provider Directory

National Provider Directory
Tax ID family
Pacific Rejuvenation Medical a Professional Corp4 organizations share this tax ID, including this one
Part of
Pacific Rejuvenation Medical a Professional Corp

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444003200000",
    "number": "1831519156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 N BEVERLY GLEN CIR",
            "address_2": "SUITE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900771726",
            "telephone_number": "310-943-4180",
            "fax_number": "888-431-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 MEDICAL CENTER DR",
            "address_2": "SUITE 302",
            "city": "WEST HILLS",
            "state": "CA",
            "postal_code": "913071907",
            "telephone_number": "818-518-5980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC REJUVENATION MEDICAL, A PROFESSIONAL CORP.",
        "enumeration_date": "2014-04-25",
        "last_updated": "2015-10-05",
        "status": "A",
        "authorized_official_last_name": "FARKAS",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-518-5980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G56249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; 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.