Active NPI
Isreal Revivo
- Marriage & Family Therapist
- Roseville, CA
National Provider Identifier
1902623325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 3400 Douglas Blvd Ste 170
Roseville, CA 95661-4281 - Phone
- (818) 406-6689
- NPI assigned
- Sep 25, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
3400 Douglas Blvd Ste 170
Roseville, CA 95661-4281
Mailing address
10443 Arminta St
Sun Valley, CA 91352-4109
Phone (818) 406-6689
Other practice location 1
10443 Arminta St
Sun Valley, CA 91352-4109
Phone (818) 406-6689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Interoperability endpoints
- telemed2u.isrealrevivo@160918.advancedmd-direct.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729209600000",
"number": "1902623325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10443 ARMINTA ST",
"city": "SUN VALLEY",
"state": "CA",
"postal_code": "913524109",
"telephone_number": "818-406-6689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 DOUGLAS BLVD STE 170",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956614281",
"telephone_number": "818-406-6689"
}
],
"practiceLocations": [
{
"address_1": "10443 Arminta St",
"address_purpose": "LOCATION",
"city": "Sun Valley",
"state": "CA",
"postal_code": "913524109",
"country_code": "US",
"telephone_number": "818-406-6689",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REVIVO",
"first_name": "ISREAL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-25",
"last_updated": "2024-10-18",
"certification_date": "2024-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.