Provider Demographics
NPI:1023889003
Name:REVIVE MENTAL HEALTH INC
Entity type:Organization
Organization Name:REVIVE MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHITRIC NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:AIZZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP/ PMHNP
Authorized Official - Phone:951-496-7912
Mailing Address - Street 1:15447 ANACAPA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2490
Mailing Address - Country:US
Mailing Address - Phone:442-255-4087
Mailing Address - Fax:442-255-4071
Practice Address - Street 1:15447 ANACAPA RD STE 200
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2490
Practice Address - Country:US
Practice Address - Phone:442-255-4087
Practice Address - Fax:442-255-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty