Revitalize Wellness Center Inc

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

REVITALIZE WELLNESS CENTER INC

Practice address

2501 W Shaw Ave Ste 113
Fresno, CA 93711-3307

Phone

(559) 507-3760

Fax

(539) 238-2199

NPI assigned

Oct 18, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shazia Tabasum MalikNPI 1104461938

Title

NP

Phone

(559) 507-3760

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shazia Tabasum Malik, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Fresno, CA
  • NPI 1104461938

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776124800000",
    "number": "1003637448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5170 N FLOYD AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937239435",
            "telephone_number": "559-507-3760",
            "fax_number": "539-238-2199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W SHAW AVE STE 113",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113307",
            "telephone_number": "559-507-3760",
            "fax_number": "539-238-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE WELLNESS CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-18",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "SHAZIA",
        "authorized_official_middle_name": "TABASUM",
        "authorized_official_title_or_position": "NP",
        "authorized_official_telephone_number": "559-507-3760"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miguel Retamoza
• Lysset Retana
• Stephen Rettig
• Amber Rachelle Reusch, PTA
• Faustino Reveles, RN
• John Daniel Rexroat
• Katherine Martinez Rexroat, L.M.F.T.
• Stephanie Reyes Meza
• Reyes Non Medical Transportation
• Reyes Rheumatology PC

• Psychiatric/Mental Health Nurse Practitioner in Fresno, CA
• Providers in Fresno, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.