Revive Medical of San Diego

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

REVIVE MEDICAL OF SAN DIEGO

Practice address

7220 Trade St Ste 209
San Diego, CA 92121-2326

Phone

(858) 800-1006

NPI assigned

Feb 21, 2019

Organization subpart

No

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

Authorized official

Name

Kevin Brown, DCNPI 1760493506

Title

Owner/Provider

Phone

(951) 440-1652

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Kevin Thomas Brown, MD

  • Psychiatry Physician
  • Vernon, TX
  • NPI 1760493506
  NPD (past) Authorized official
• William Daniel Cullins, D.C.

  • Chiropractor
  • Hemet, CA
  • NPI 1275605545
  NPD (past)

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550707200000",
    "number": "1114484573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7220 TRADE ST STE 209",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212326",
            "telephone_number": "858-800-1006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7220 TRADE ST STE 209",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212326",
            "telephone_number": "858-800-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL OF SAN DIEGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-21",
        "last_updated": "2019-02-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "951-440-1652",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Revell
• Chrystine Rae Revelli, FNP-C
• Janet Mary Revels, PMHNP
• Revival DME Corp
• Revivamed Medical Corporation
• Revive Medspa
• Revive Psychiatric Center
• Revive Salon and Spa
• George Albert Rew, CERTIFICATION
• Diane Rexin

• General Practice Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; 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.