NPIMap

Organization Active NPI

Revive Medspa

  • Clinic/Center
  • San Diego, CA
National Provider Identifier
1356130884
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
REVIVE MEDSPA
Practice address
1425 Frazee Rd
San Diego, CA 92108-4347
Phone
(619) 293-7233
NPI assigned
May 1, 2025
Last updated
May 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2025

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

Authorized official

Name
Vishal Verma, MD
Title
Owner
Phone
(619) 293-7233

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1425 Frazee Rd
San Diego, CA 92108-4347

Mailing address

1425 Frazee Rd
San Diego, CA 92108-4347
Phone (619) 293-7233

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1746057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1356130884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 FRAZEE RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084347",
            "telephone_number": "619-293-7233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 FRAZEE RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084347",
            "telephone_number": "619-293-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDSPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-01",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "VERMA",
        "authorized_official_first_name": "VISHAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-293-7233",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; 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.