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General NPI Number Information
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NPI Number | 1659912905
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Entity Type | Organization
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Legal Business Name | REVIVE,A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 4310 TRADEWINDS DR STE 300
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City | OXNARD
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State | CA
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Zip | 93035-1410
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Country | US
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Telephone | 805-889-2511
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Fax | 866-242-5109
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Provider Business Mailing Address
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Address Line | 4310 TRADEWINDS DR STE 300
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City | OXNARD
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State | CA
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Zip | 93035-1410
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Country | US
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Telephone | 661-993-8941
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Fax | 866-242-5109
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PAUL S WEINBERG
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Credential | MD
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Telephone | 907-442-3321
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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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