| Revitalize Life Center a PC | |
|
3939 Atlantic Ave Ste 100 Long Beach CA 90807-3529 | |
| (562) 457-6010 | |
| (562) 424-5600 |
| Full Name | Revitalize Life Center a PC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3939 Atlantic Ave Ste 100, Long Beach, California |
| Authorized Official Name and Position | Ebony D Foster (BILLING SUPPORT) |
| Authorized Official Contact | 5624576010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalize Life Center a PC 3939 Atlantic Ave Ste 100 Long Beach CA 90807-3529 Ph: (562) 457-6010 | Revitalize Life Center a PC 3939 Atlantic Ave Ste 100 Long Beach CA 90807-3529 Ph: (562) 457-6010 |
| NPI Number | 1679102248 |
|---|---|
| Provider Enumeration Date | 04/06/2020 |
| Last Update Date | 04/06/2020 |
| Certification Date | 04/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679102248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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