Revival DME Corp

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

REVIVAL DME CORP

Practice address

4025 Camino del Rio S Ste 300
San Diego, CA 92108-4108

Phone

(619) 542-7738

NPI assigned

Oct 27, 2018

Organization subpart

No

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

Authorized official

Name

Kim Gowdy Jefferson

Title

President

Phone

(951) 490-3751

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1540598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540598400000",
    "number": "1609343797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 CAMINO DEL RIO S STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084108",
            "telephone_number": "619-542-7738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 CAMINO DEL RIO S STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084108",
            "telephone_number": "619-542-7738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL DME CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-27",
        "last_updated": "2018-10-27",
        "status": "A",
        "authorized_official_last_name": "JEFFERSON",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "GOWDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-490-3751"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlos Reveles, LVN
• Shanae Revell
• Thomas Revell
• Chrystine Rae Revelli, FNP-C
• Janet Mary Revels, PMHNP
• Revivamed Medical Corporation
• Revive Medical of San Diego
• Revive Medspa
• Revive Psychiatric Center
• Revive Salon and Spa

• Durable Medical Equipment & Medical Supplies in San Diego, CA
• Providers in San Diego, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2018; 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.