Revive Orthopaedic Institute, Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A68137 Issued in CA

Legal business name

REVIVE ORTHOPAEDIC INSTITUTE, INC

Practice address

6010 Hidden Valley Rd
Ste 210
Carlsbad, CA 92011-4213

Phone

(760) 295-2995

Fax

(760) 295-2906

NPI assigned

Sep 29, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Christian Bentley, MD

Title

Partial Owner

Phone

(760) 295-2995

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1443484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443484800000",
    "number": "1922478221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 N EL CAMINO REAL STE F",
            "address_2": "STE 219",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920242874",
            "telephone_number": "760-295-2995",
            "fax_number": "760-295-2906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6010 HIDDEN VALLEY RD",
            "address_2": "STE 210",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920114213",
            "telephone_number": "760-295-2995",
            "fax_number": "760-295-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE ORTHOPAEDIC INSTITUTE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-29",
        "last_updated": "2015-09-29",
        "status": "A",
        "authorized_official_last_name": "BENTLEY",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "PARTIAL OWNER",
        "authorized_official_telephone_number": "760-295-2995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A68137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; 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.