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General NPI Number Information
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NPI Number | 1295693588
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Entity Type | Organization
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Legal Business Name | REVIVE 3.2 WELLNESS NURSING PC
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 10328 RESEDA BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91326-3433
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Country | US
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Telephone | 818-634-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 10328 RESEDA BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91326-3433
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Country | US
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Telephone | 818-634-0082
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/CEO
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Name | MS. DIANNE KRISTINE PALASIO
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Credential | NP
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Telephone | 818-634-0082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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