| Vida Revival LLC | |
|
3180 Willow Ln Ste 114 Thousand Oaks CA 91361-4984 | |
| (818) 232-8432 | |
| (818) 232-8433 |
| Full Name | Vida Revival LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3180 Willow Ln Ste 114, Thousand Oaks, California |
| Authorized Official Name and Position | Diana Alavi (OWNER) |
| Authorized Official Contact | 8182328432 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vida Revival LLC 3180 Willow Ln Ste 114 Thousand Oaks CA 91361-4984 Ph: (818) 232-8432 | Vida Revival LLC 3180 Willow Ln Ste 114 Thousand Oaks CA 91361-4984 Ph: (818) 232-8432 |
| NPI Number | 1952115149 |
|---|---|
| Provider Enumeration Date | 02/06/2025 |
| Last Update Date | 02/06/2025 |
| Certification Date | 02/06/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952115149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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