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General NPI Number Information
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NPI Number | 1871311076
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Entity Type | Organization
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Legal Business Name | REVIVAL MED CENTERS, LLC
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Dates
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Enumeration Date | 09/27/2024
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 8353 SW 124TH ST STE 207A
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City | MIAMI
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State | FL
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Zip | 33156-5847
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Country | US
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Telephone | 786-443-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 8353 SW 124TH ST STE 207A
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City | MIAMI
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State | FL
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Zip | 33156-5847
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Country | US
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Telephone | 786-443-5833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSA ALBA PEREZ
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Credential |
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Telephone | 561-886-8459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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