Healthcare Provider Details

I. General information

NPI: 1285102525
Provider Name (Legal Business Name): REVIVE ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20315 VENTURA BLVD STE 315A
WOODLAND HILLS CA
91364-2449
US

IV. Provider business mailing address

20315 VENTURA BLVD STE 315A
WOODLAND HILLS CA
91364-2449
US

V. Phone/Fax

Practice location:
  • Phone: 818-854-6427
  • Fax: 818-854-6428
Mailing address:
  • Phone: 818-854-6427
  • Fax: 818-854-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANO SHANAA
Title or Position: DIRECTOR
Credential: MD
Phone: 818-854-6427