Revive Men'S Health Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

REVIVE MEN'S HEALTH INC

Practice address

13309 Van Nuys Blvd
Pacoima, CA 91331-3006

Phone

(818) 476-4717

Fax

(818) 476-4718

NPI assigned

Sep 17, 2024

Organization subpart

No

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

Authorized official

Name

Manuk Chulyan, PA-C

Title

Practice Owner

Phone

(818) 476-4717

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1346077989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13309 VAN NUYS BLVD",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913313006",
            "telephone_number": "818-476-4717",
            "fax_number": "818-476-4718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13309 VAN NUYS BLVD",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913313006",
            "telephone_number": "818-476-4717",
            "fax_number": "818-476-4718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEN'S HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "CHULYAN",
        "authorized_official_first_name": "MANUK",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "818-476-4717",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Pacoima, CA
• Providers in Pacoima, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.