| Reviv Functional Psychiatry & Tms Wellness Center | |
|
1400 N Harbor Blvd Ste 540 Fullerton CA 92835-4142 | |
| (714) 871-9357 | |
| (714) 871-9362 |
| Full Name | Reviv Functional Psychiatry & Tms Wellness Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1400 N Harbor Blvd Ste 540, Fullerton, California |
| Authorized Official Name and Position | Hina Sidhu (OWNER/PROVIDER) |
| Authorized Official Contact | 7148719357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reviv Functional Psychiatry & Tms Wellness Center 1400 N Harbor Blvd Ste 540 Fullerton CA 92835-4142 Ph: (714) 871-9357 | Reviv Functional Psychiatry & Tms Wellness Center 1400 N Harbor Blvd Ste 540 Fullerton CA 92835-4142 Ph: (714) 871-9357 |
| NPI Number | 1114335239 |
|---|---|
| Provider Enumeration Date | 08/01/2014 |
| Last Update Date | 06/24/2024 |
| Certification Date | 06/24/2024 |
| Medicare PECOS PAC ID | 3476771304 |
|---|---|
| Medicare Enrollment ID | O20140905001235 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114335239 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Hina Sidhu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194919803 PECOS PAC ID: 7517046030 Enrollment ID: I20080508000205 |
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