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General NPI Number Information
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NPI Number | 1104784297
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Entity Type | Organization
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Legal Business Name | REVIVE INJECTION CLINIC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 27833 AVENUE HOPKINS STE 6
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City | VALENCIA
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State | CA
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Zip | 91355-4562
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Country | US
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Telephone | 661-407-8507
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Fax |
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Provider Business Mailing Address
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Address Line | 28207 TANGERINE LN
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City | SANTA CLARITA
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State | CA
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Zip | 91350-3257
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Country | US
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Telephone | 818-536-8165
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Fax | 818-536-8165
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Authorized Official
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Title or Position | CO-OWNER
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Name | JENNA GOODWIN
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Credential | FNP-C
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Telephone | 818-536-8165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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