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General NPI Number Information
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NPI Number | 1710668496
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Entity Type | Organization
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Legal Business Name | REVIVE MEDICAL CARE
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 239 N LITCHFIELD RD
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City | GOODYEAR
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State | AZ
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Zip | 85338-1249
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Country | US
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Telephone | 480-549-8865
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Fax | 520-391-2936
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Provider Business Mailing Address
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Address Line | 12317 W LARKSPUR RD
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City | EL MIRAGE
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State | AZ
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Zip | 85335-5286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESUS RYAN ARVIZO JR.
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Credential | FNP-C
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Telephone | 480-549-8865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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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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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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