Provider Demographics
NPI:1487291142
Name:CORPUS CHRISTI REGENERATIVE THERAPY PLLC
Entity type:Organization
Organization Name:CORPUS CHRISTI REGENERATIVE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:ARLINE
Authorized Official - Last Name:ANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:NEONATAL NURSE PRACT
Authorized Official - Phone:361-215-0083
Mailing Address - Street 1:5309 WILLIAMS DR STE B
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4638
Mailing Address - Country:US
Mailing Address - Phone:361-851-0545
Mailing Address - Fax:361-991-4673
Practice Address - Street 1:5309 WILLIAMS DR STE B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4638
Practice Address - Country:US
Practice Address - Phone:361-851-0545
Practice Address - Fax:361-991-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty