Healthcare Provider Details

I. General information

NPI: 1962295410
Provider Name (Legal Business Name): REVITALIZE MEDICAL CENTER NAPLES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 STRAND BLVD STE 501
NAPLES FL
34110-7384
US

IV. Provider business mailing address

5625 STRAND BLVD STE 501
NAPLES FL
34110-7384
US

V. Phone/Fax

Practice location:
  • Phone: 786-359-4999
  • Fax: 786-359-4843
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRTHA VALDES
Title or Position: MANAGER
Credential:
Phone: 239-443-8369