Revive Salon and Spa

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95005931 Issued in CA

Legal business name

REVIVE SALON AND SPA

Practice address

5965 Village Way
E207
San Diego, CA 92130-2475

Phone

(619) 293-7233

NPI assigned

Feb 6, 2017

Organization subpart

No

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

Authorized official

Name

Mary Lynn Elizabeth Eichert, NP

Title

Nurse Practitioner

Phone

(704) 516-6782

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.

• Kayla Hillygus, FNP

  • Family Nurse Practitioner
  • San Diego, CA
  • NPI 1659063931
  NPD (past)
• Chantal C Sy, NP

  • Family Nurse Practitioner
  • Encinitas, CA
  • NPI 1568053908
  NPD (past)

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

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1619415072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 MOUNT HUKEE AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921174738",
            "telephone_number": "704-516-6782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5965 VILLAGE WAY",
            "address_2": "E207",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921302475",
            "telephone_number": "619-293-7233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE SALON AND SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "EICHERT",
        "authorized_official_first_name": "MARY LYNN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "704-516-6782",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95005931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Revival DME Corp
• Revivamed Medical Corporation
• Revive Medical of San Diego
• Revive Medspa
• Revive Psychiatric Center
• George Albert Rew, CERTIFICATION
• Diane Rexin
• Gerald Samuel Rey, PSY.D.
• Trina Marie Rey, RN, BSN, PHN
• Gizem Meliha Reyal

• Family Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; 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.