Healthcare Provider Details

I. General information

NPI: 1750832333
Provider Name (Legal Business Name): IV REVIVAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8752 E VIA DE COMMERCIO SUITE 2
SCOTTSDALE AZ
85258-3396
US

IV. Provider business mailing address

8752 E VIA DE COMMERCIO SUITE 2
SCOTTSDALE AZ
85258-3396
US

V. Phone/Fax

Practice location:
  • Phone: 480-848-1678
  • Fax:
Mailing address:
  • Phone: 480-848-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: CAREY CATANIA
Title or Position: PRESIDENT
Credential: CRNA
Phone: 480-848-1678