| Revive Pathway | |
|
1240 Broadway El Cajon CA 92021-4994 | |
| (619) 841-1310 | |
| Not Available |
| Full Name | Revive Pathway |
|---|---|
| Speciality | Clinic/Center |
| Location | 1240 Broadway, El Cajon, California |
| Authorized Official Name and Position | Judson Lea (COO) |
| Authorized Official Contact | 6198411310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Pathway 6650 Gunpark Dr Boulder CO 80301-7002 Ph: (619) 841-1310 | Revive Pathway 1240 Broadway El Cajon CA 92021-4994 Ph: (619) 841-1310 |
| NPI Number | 1962117440 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 05/06/2026 |
| Certification Date | 05/06/2026 |
| Medicare PECOS PAC ID | 4284081639 |
|---|---|
| Medicare Enrollment ID | O20231107003264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962117440 | NPI | - | NPPES |
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