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General NPI Number Information
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NPI Number | 1083087613
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Entity Type | Organization
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Legal Business Name | REVIVEX HEALTHCARE INC
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 23150 CRENSHAW BLVD STE 100
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City | TORRANCE
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State | CA
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Zip | 90505-3025
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Country | US
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Telephone | 310-437-7399
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Fax | 888-431-8819
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Provider Business Mailing Address
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Address Line | 23150 CRENSHAW BLVD STE 100
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City | TORRANCE
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State | CA
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Zip | 90505-3025
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Country | US
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Telephone | 104-377-3993
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Fax | 210-437-7398
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Authorized Official
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Title or Position | OWNER
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Name | KARTIK ANANTH
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Credential |
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Telephone | 310-437-7399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | A109016
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License Number State |
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