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General NPI Number Information
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NPI Number | 1962295410
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Entity Type | Organization
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Legal Business Name | REVITALIZE MEDICAL CENTER NAPLES, LLC
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 5625 STRAND BLVD STE 501
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City | NAPLES
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State | FL
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Zip | 34110-7384
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Country | US
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Telephone | 786-359-4999
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Fax | 786-359-4843
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Provider Business Mailing Address
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Address Line | 5625 STRAND BLVD STE 501
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City | NAPLES
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State | FL
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Zip | 34110-7384
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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 | MANAGER
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Name | MIRTHA VALDES
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Credential |
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Telephone | 239-443-8369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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