Healthcare Provider Details

I. General information

NPI: 1255177242
Provider Name (Legal Business Name): REVIVE SURGERY CENTER PASADENA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S ARROYO PKWY FL 3
PASADENA CA
91105-2581
US

IV. Provider business mailing address

333 S ARROYO PKWY FL 3
PASADENA CA
91105-2581
US

V. Phone/Fax

Practice location:
  • Phone: 626-537-3737
  • Fax: 626-537-3738
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVUNI HARRISON
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 909-710-2020