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General NPI Number Information
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NPI Number | 1245003730
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Entity Type | Organization
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Legal Business Name | MEN'S REVIVAL LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 8752 E VIA DE COMMERCIO STE 2
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3396
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Country | US
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Telephone | 602-935-4655
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Fax | 833-469-2578
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Provider Business Mailing Address
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Address Line | 8752 E VIA DE COMMERCIO STE 2
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3396
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Country | US
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Telephone | 602-935-4655
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Fax | 833-469-2578
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Authorized Official
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Title or Position | CO-OWNER
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Name | MEGAN JORE
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Credential | RN
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Telephone | 757-754-0938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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