| Revital Medical Health Group Llc | |
|
17064 W Dixie Hwy N Miami Beach FL 33160-3723 | |
| (305) 949-4964 | |
| (305) 948-6519 |
| Full Name | Revital Medical Health Group Llc |
|---|---|
| Speciality | General Practice |
| Location | 17064 W Dixie Hwy, N Miami Beach, Florida |
| Authorized Official Name and Position | Pierre A. Gaston (PRESIDENT) |
| Authorized Official Contact | 3059494964 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revital Medical Health Group Llc 17064 W Dixie Hwy North Miami Beach FL 33160-3723 Ph: (305) 949-4964 | Revital Medical Health Group Llc 17064 W Dixie Hwy N Miami Beach FL 33160-3723 Ph: (305) 949-4964 |
| NPI Number | 1679887053 |
|---|---|
| Provider Enumeration Date | 07/28/2010 |
| Last Update Date | 09/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679887053 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME 41852 (Florida) | Primary |
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