| Revitalize Care Center Inc | |
|
850 Nw 42nd Ave Ste 300 Miami FL 33126-4168 | |
| (786) 636-8084 | |
| Not Available |
| Full Name | Revitalize Care Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 850 Nw 42nd Ave Ste 300, Miami, Florida |
| Authorized Official Name and Position | Adriadna Dorta (PRESIDENT) |
| Authorized Official Contact | 7866368084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Care Center Inc 850 Nw 42nd Ave Ste 300 Miami FL 33126-4168 Ph: (786) 636-8084 | Revitalize Care Center Inc 850 Nw 42nd Ave Ste 300 Miami FL 33126-4168 Ph: (786) 636-8084 |
| NPI Number | 1902620735 |
|---|---|
| Provider Enumeration Date | 11/08/2024 |
| Last Update Date | 04/25/2025 |
| Medicare PECOS PAC ID | 8527582451 |
|---|---|
| Medicare Enrollment ID | O20250411002333 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902620735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Hendry J Perez Pascual |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437577012 PECOS PAC ID: 1658642384 Enrollment ID: I20201022000064 |
| Provider Name | Claudia Fernandez De Lara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134834583 PECOS PAC ID: 4587024336 Enrollment ID: I20230712002506 |
| Provider Name | Belkis Rosario Caballero Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346016383 PECOS PAC ID: 6204346018 Enrollment ID: I20250610004291 |
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