Revitalize Life Center a PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

REVITALIZE LIFE CENTER A PC

Practice address

3939 Atlantic Ave Ste 100
Long Beach, CA 90807-3529

Phone

(562) 457-6010

Fax

(562) 424-5600

NPI assigned

Apr 6, 2020

Organization subpart

No

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

Authorized official

Name

Ebony D Foster

Title

Billing Support

Phone

(562) 457-6010

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1679102248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 ATLANTIC AVE STE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073529",
            "telephone_number": "562-457-6010",
            "fax_number": "562-424-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 ATLANTIC AVE STE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073529",
            "telephone_number": "562-457-6010",
            "fax_number": "562-424-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE LIFE CENTER A PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "EBONY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "BILLING SUPPORT",
        "authorized_official_telephone_number": "562-457-6010"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Retina Institute of California Medical Group, a California Medical Par
• Retirement Housing Foundation
• Veronica Florez Reveles-Godinez, LMFT
• Diana Reveles
• Felicia Revero
• Revitalize Rehab Club
• Revolving Door Resolution Center
• Desiree Rew, LCSW
• Georgia Marie Rew
• Rex J. Winters,MD ;Inc

• Internal Medicine Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; 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.