Provider Demographics
NPI:1659912905
Name:REVIVE,A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:REVIVE,A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-442-3321
Mailing Address - Street 1:4310 TRADEWINDS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1410
Mailing Address - Country:US
Mailing Address - Phone:661-993-8941
Mailing Address - Fax:866-242-5109
Practice Address - Street 1:4310 TRADEWINDS DR STE 300
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1410
Practice Address - Country:US
Practice Address - Phone:805-889-2511
Practice Address - Fax:866-242-5109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty