Healthcare Provider Details

I. General information

NPI: 1265168587
Provider Name (Legal Business Name): RI-VIVE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 W TEXAS ST STE 115
FAIRFIELD CA
94533-5952
US

IV. Provider business mailing address

1250 OLIVER RD # 1116
FAIRFIELD CA
94534-3467
US

V. Phone/Fax

Practice location:
  • Phone: 707-470-2888
  • Fax: 866-626-0793
Mailing address:
  • Phone: 707-386-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRMARITA LEWIS
Title or Position: FAMILY NURSE PRACITIONER
Credential: NP
Phone: 707-470-2888