REVIVE SALON AND SPA NPI 1619415072

NPI Information

NPI: 1619415072
Provider Name: REVIVE SALON AND SPA
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
5965 VILLAGE WAY
E207
SAN DIEGO, CA
ZIP 92130
Phone: (619) 293-7233
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REVIVE SALON AND SPA is a family nurse practitioner in San Diego, CA. REVIVE SALON AND SPA NPI is 1619415072. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5965 VILLAGE WAY
E207
SAN DIEGO, CA
ZIP 92130-475
Phone: (619) 293-7233

The provider's authorized official is Mary Lynn Elizabeth Eichert .
The authorized official title is Nurse Practitioner and has the following contact phone number (704) 516-6782.

The enumeration date for this NPI number is 2/6/2017 and was last updated on 2/6/2017.

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	363LF0000X	Nurse Practitioner	Family	95005931	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: 4/28/2024

NPI Synchronization or Removal

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