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REVIVEX HEALTHCARE INC NPI 1174800452


NPI Information

NPI: 1174800452
Provider Name: REVIVEX HEALTHCARE INC

Doing Business As: PACIFIC PAIN & WELLNESS GROUP

Classification: Psychiatry & Neurology - 2084P2900X
Entity Type: Organization

Specialization: Pain Medicine

CLIA Number: 05D2072919

Address:
23510 CRENSHAW BLVD STE 100
TORRANCE, CA
ZIP 90505
Phone: (310) 437-7399
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REVIVEX HEALTHCARE INC is a pain medicine psychiatry neurology in Torrance, CA. The provider is a neurologist, child neurologists or psychiatrist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. REVIVEX HEALTHCARE INC NPI is 1174800452. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Pacific Pain & Wellness Group.

The provider's business location address is:

23510 CRENSHAW BLVD STE 100
TORRANCE, CA
ZIP 90505-203
Phone: (310) 437-7399
Fax: (310) 437-7398

The provider's authorized official is Kartik Ananth .
The authorized official title is President and has the following contact phone number (310) 437-7399.

The CLIA number assigned to this NPI record is 05D2072919 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/15/2011 and was last updated on 2/28/2019.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208VP0014XPain MedicineInterventional Pain MedicineCALIFORNIANo
2103TC0700XPsychologistClinicalCALIFORNIANo
3208100000XPhysical Medicine & RehabilitationCALIFORNIANo
42084P0800XPsychiatry & NeurologyPsychiatryCALIFORNIANo
52084P2900XPsychiatry & NeurologyPain MedicineCALIFORNIAYes

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

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