Healthcare Provider Details

I. General information

NPI: 1417843749
Provider Name (Legal Business Name): RWC RVIVE STA CLARITA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27125 SIERRA HWY STE 325
SANTA CLARITA CA
91351-5432
US

IV. Provider business mailing address

27125 SIERRA HWY STE 325
SANTA CLARITA CA
91351-5432
US

V. Phone/Fax

Practice location:
  • Phone: 661-221-5688
  • Fax: 661-221-5688
Mailing address:
  • Phone: 661-221-5688
  • Fax: 661-221-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HEIDI HAGMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 661-221-5688