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General NPI Number Information
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NPI Number | 1417843749
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Entity Type | Organization
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Legal Business Name | RWC RVIVE STA CLARITA, PC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 27125 SIERRA HWY STE 325
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City | SANTA CLARITA
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State | CA
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Zip | 91351-5432
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Country | US
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Telephone | 661-221-5688
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Fax | 661-221-5688
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Provider Business Mailing Address
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Address Line | 27125 SIERRA HWY STE 325
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City | SANTA CLARITA
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State | CA
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Zip | 91351-5432
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Country | US
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Telephone | 661-221-5688
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Fax | 661-221-5688
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HEIDI HAGMAN
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Credential | MD
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Telephone | 661-221-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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