CORE REVIVE / SOUL REVIVE LLC NPI 1154826980

NPI Information

NPI: 1154826980
Provider Name: CORE REVIVE / SOUL REVIVE LLC

Doing Business As: CORE REVIVE

Classification: Registered Nurse - 163WN1003X
Entity Type: Organization

Specialization: Nutrition Support

Address:
16 QUEENS LN
PETALUMA, CA
ZIP 94952
Phone: (707) 559-5347
Get Directions

CORE REVIVE / SOUL REVIVE LLC is a nutrition support registered nurse in Petaluma, CA. CORE REVIVE / SOUL REVIVE LLC NPI is 1154826980. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Core Revive.

The provider's business location address is:

16 QUEENS LN
PETALUMA, CA
ZIP 94952-047
Phone: (707) 559-5347

The provider's authorized official is Philip Anthony Diehl .
The authorized official title is Partner and has the following contact phone number (415) 250-7118.

The enumeration date for this NPI number is 3/26/2018 and was last updated on 6/11/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WD0400X	Registered Nurse	Diabetes Educator	846331	CALIFORNIA	No
2	163WN1003X	Registered Nurse	Nutrition Support	846331	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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