Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Pacific Rejuvenation Medical, a Professional Corp

Organization Non-Pharmacy Dispensing Site · NPI 1023428521

Pacific Rejuvenation Medical, a Professional Corp is a Non-Pharmacy Dispensing Site in Los Angeles, California. Licensed in California. Registered with an NPI since 2014.

Licensed in
CA
In the registry since
2014
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

6310 San Vicente Blvd Ste 220
Los Angeles, CA 90048-5426
Phone: (818) 518-5980
Fax: (818) 337-2049
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Non-Pharmacy Dispensing Site (primary) Taxonomy 332900000X · Licence G44674 (CA)

Record details

NPI number1023428521
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationPacific Rejuvenation Medical, a Professional Corp
Authorized official Lynn Goodloe — Medical Director · (818) 518-5980
NPI enumeratedMay 6, 2014
Last updated in NPPESOctober 5, 2015
Mailing address2980 N Beverly Glen Cir, Suite 100, Los Angeles, CA 90077-1726

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