Revive Wellness Center

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

95003531 Issued in CA

Legal business name

REVIVE WELLNESS CENTER

Practice address

22330 Hawthorne Blvd
Suite J
Torrance, CA 90505-2536

Phone

(310) 375-7599

Fax

(310) 414-0777

NPI assigned

Dec 14, 2015

Organization subpart

No

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

Authorized official

Name

Shonda Chase, FNP

Title

Owner

Phone

(310) 375-7599

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1013372242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22330 HAWTHORNE BLVD",
            "address_2": "SUITE J",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905052536",
            "telephone_number": "310-375-7599",
            "fax_number": "310-414-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22330 HAWTHORNE BLVD",
            "address_2": "SUITE J",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905052536",
            "telephone_number": "310-375-7599",
            "fax_number": "310-414-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "CHASE",
        "authorized_official_first_name": "SHONDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-375-7599",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "95003531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Retina Institute of California Medical Group, a California Medical Par
• Retina Macula Institute
• John Richard a. Retodo, D.M.D
• Nancy Jo Rettig, LMFT
• Reinald Allen Revilla, PMHNP
• Revivex Healthcare Inc
• Revivex Healthcare Inc
• Ulyssa Revolvo
• Stephanie Rey, STEPHANIE
• Juana Reyes Andrade

• Medical Specialty Clinic/Center in Torrance, CA
• Providers in Torrance, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; 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.