Provider Demographics
NPI:1447031273
Name:FAMILY MEDICINE AND REJUVENATION THERAPIES
Entity type:Organization
Organization Name:FAMILY MEDICINE AND REJUVENATION THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:720-276-8251
Mailing Address - Street 1:200 VINTON RD
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-7047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 VINTON RD
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-7047
Practice Address - Country:US
Practice Address - Phone:720-276-8251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care