| Revivify Restorative Medicine | |
|
16445 Bernardo Center Dr San Diego CA 92128-2523 | |
| (858) 429-0099 | |
| (858) 676-1172 |
| Full Name | Revivify Restorative Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 16445 Bernardo Center Dr, San Diego, California |
| Authorized Official Name and Position | Stephen M Daquino (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8584290099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revivify Restorative Medicine 16445 Bernardo Center Dr San Diego CA 92128-2523 Ph: (858) 429-0099 | Revivify Restorative Medicine 16445 Bernardo Center Dr San Diego CA 92128-2523 Ph: (858) 429-0099 |
| NPI Number | 1003164385 |
|---|---|
| Provider Enumeration Date | 08/17/2012 |
| Last Update Date | 07/29/2020 |
| Medicare PECOS PAC ID | 7416107149 |
|---|---|
| Medicare Enrollment ID | O20121015000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003164385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 20A8442 (California) | Primary |
| Provider Name | Stephen M Daquino |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1346351665 PECOS PAC ID: 8325009582 Enrollment ID: I20041020001345 |
Nucleus Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4570 Executive Dr Ste 100, San Diego, CA 92121 Phone: 844-838-3322 | |
Moden Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8901 Activity Rd Ste 205, San Diego, CA 92126 Phone: 888-822-1184 Fax: 888-877-3676 | |
Presidio Medical Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4440 Lamont St, San Diego, CA 92109 Phone: 858-270-7633 Fax: 858-270-7692 | |
Michael L Butera Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6699 Alvarado Rd Ste 2309, San Diego, CA 92120 Phone: 619-286-8803 Fax: 619-286-2344 | |
San Diego Digestive Disease Consultants, Inc. A Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8008 Frost St, Ste 200, San Diego, CA 92123 Phone: 858-292-7527 Fax: 858-292-7804 | |
Munoz Medical Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7345 Linda Vista Rd, Suite A, San Diego, CA 92111 Phone: 858-565-2150 Fax: 858-565-2570 |