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General NPI Number Information
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NPI Number | 1003637448
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Entity Type | Organization
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Legal Business Name | REVITALIZE WELLNESS CENTER INC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 5170 N FLOYD AVE
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City | FRESNO
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State | CA
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Zip | 93723
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Country | US
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Telephone | 559-507-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 5170 N FLOYD AVE
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City | FRESNO
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State | CA
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Zip | 93723-9435
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Country | US
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Telephone | 559-507-3760
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Fax | 539-238-2199
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Authorized Official
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Title or Position | OWNER
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Name | SHAZIA MALIK
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Credential |
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Telephone | 559-507-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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