Healthcare Provider Details

I. General information

NPI: 1336064005
Provider Name (Legal Business Name): REVAXIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16432 45TH AVE E
TACOMA WA
98446-4519
US

IV. Provider business mailing address

16432 45TH AVE E
TACOMA WA
98446-4519
US

V. Phone/Fax

Practice location:
  • Phone: 90-461-8629
  • Fax:
Mailing address:
  • Phone: 904-618-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN ANGELERI
Title or Position: OWNER
Credential:
Phone: 904-618-6290