Revivify Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

REVIVIFY DERMATOLOGY, LLC

Practice address

21301 Powerline Rd # 108
Boca Raton, FL 33433-2388

Phone

(561) 877-8675

Fax

(561) 672-1365

NPI assigned

Oct 30, 2019

Organization subpart

No

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

Authorized official

Name

Denise M. Guevara, DO

Title

Medical Director

Phone

(561) 877-8675

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1699319988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21301 POWERLINE RD STE 108",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334332388",
            "telephone_number": "561-877-8675",
            "fax_number": "561-672-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21301 POWERLINE RD # 108",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334332388",
            "telephone_number": "561-877-8675",
            "fax_number": "561-672-1365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 E Broward Blvd Ste D",
            "address_purpose": "LOCATION",
            "city": "Ft Lauderdale",
            "state": "FL",
            "postal_code": "333012022",
            "country_code": "US",
            "telephone_number": "754-243-8080",
            "fax_number": "754-243-8088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVIFY DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-30",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "GUEVARA",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "561-877-8675",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.