Provider Demographics
NPI:1548823859
Name:REGENERATIVE SURGICAL, LLC
Entity type:Organization
Organization Name:REGENERATIVE SURGICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RA'KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-721-4005
Mailing Address - Street 1:3534 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1728
Mailing Address - Country:US
Mailing Address - Phone:281-721-4005
Mailing Address - Fax:855-838-6071
Practice Address - Street 1:3534 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1728
Practice Address - Country:US
Practice Address - Phone:281-721-4005
Practice Address - Fax:855-838-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR1277OtherTEXAS MEDICAL BOARD