| Revitawound Incorporated | |
|
146 N San Fernando Blvd Ste 213 Burbank CA 91502-1230 | |
| (562) 506-6577 | |
| (747) 877-8189 |
| Full Name | Revitawound Incorporated |
|---|---|
| Speciality | Internal Medicine |
| Location | 146 N San Fernando Blvd Ste 213, Burbank, California |
| Authorized Official Name and Position | Jennifer Mata (OWNER) |
| Authorized Official Contact | 5625066577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitawound Incorporated 146 N San Fernando Blvd Ste 213 Burbank CA 91502-1230 Ph: (562) 506-6577 | Revitawound Incorporated 146 N San Fernando Blvd Ste 213 Burbank CA 91502-1230 Ph: (562) 506-6577 |
| NPI Number | 1538982533 |
|---|---|
| Provider Enumeration Date | 11/07/2024 |
| Last Update Date | 11/19/2024 |
| Medicare PECOS PAC ID | 2466982434 |
|---|---|
| Medicare Enrollment ID | O20250205002932 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538982533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ashwani Bhardwaj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457427197 PECOS PAC ID: 2466551213 Enrollment ID: I20110106000379 |
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