Revitalize Health Center LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

REVITALIZE HEALTH CENTER LLC

Practice address

5285 Summerlin Rd Ste 101
Fort Myers, FL 33919-7601

Phone

(239) 291-6633

Fax

(239) 385-0644

NPI assigned

May 27, 2025

Organization subpart

No

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

Authorized official

Name

Meivys E Avila Castro

Title

Manager

Phone

(239) 291-6633

Specialties & licenses 1

Addresses

Other names 1

• Revitalize Health Care Center of Fort Myers Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Darvis Eduardo Dager Lissabet, MD

  • General Practice Physician
  • Cape Coral, FL
  • NPI 1720765506
  Medicare reassignment Care Compare group NPD
• Vikti Gosalia, M.D.

  • Internal Medicine Physician
  • Port Charlotte, FL
  • NPI 1952537680
  Medicare reassignment Care Compare group NPD
• Rene Perez Garcia, APRN

  • Family Nurse Practitioner
  • Lehigh Acres, FL
  • NPI 1427765544
  Medicare reassignment Care Compare group NPD
• Christopher SC Blaisdell, D.O.

  • Neuromusculoskeletal Medicine & OMM Physician
  • Hialeah, FL
  • NPI 1013212331
  Medicare reassignment Care Compare group
• Jose Gabriel Chavez, PMHNP-BC, AGACNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Sunrise, FL
  • NPI 1043026008
  Care Compare group

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

{
    "created_epoch": "1748304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756425600000",
    "number": "1689467136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5285 SUMMERLIN RD STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339197601",
            "telephone_number": "239-291-6633",
            "fax_number": "239-385-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5285 SUMMERLIN RD STE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339197601",
            "telephone_number": "239-291-6633",
            "fax_number": "239-385-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-27",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A",
        "authorized_official_last_name": "AVILA CASTRO",
        "authorized_official_first_name": "MEIVYS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "239-291-6633"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revitalize Health Care Center of Fort Myers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Retina Health Center PL
• Kirby Retzer
• Cori J. Revak, PSY.D.
• Tifani Megan Revels Lee, LMT
• Revitalize Counseling
• Revive Family Counseling, L.L.C.
• Revive Pharmacy Inc
• Manuel Revuelta, MD
• Gustavo Rey, MD
• Eric W Reyes Grajales, M.D.

• General Practice Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.