Provider Demographics
NPI:1720598303
Name:REVIVAL RESEARCH
Entity Type:Organization
Organization Name:REVIVAL RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HANSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-982-8892
Mailing Address - Street 1:8200 NW 27TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1902
Mailing Address - Country:US
Mailing Address - Phone:305-982-8892
Mailing Address - Fax:
Practice Address - Street 1:8200 NW 27TH ST STE 116
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1902
Practice Address - Country:US
Practice Address - Phone:305-982-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch