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General NPI Number Information
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NPI Number | 1902620735
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Entity Type | Organization
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Legal Business Name | REVITALIZE CARE CENTER INC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 850 NW 42ND AVE STE 300
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City | MIAMI
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State | FL
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Zip | 33126-4168
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Country | US
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Telephone | 786-636-8084
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Fax |
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Provider Business Mailing Address
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Address Line | 850 NW 42ND AVE STE 300
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City | MIAMI
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State | FL
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Zip | 33126-4168
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Country | US
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Telephone | 786-636-8084
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ADRIADNA DORTA
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Credential |
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Telephone | 786-636-8084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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