| Revive Medical Group Ca Pc | |
|
914 Pine St Mount Shasta CA 96067-2143 | |
| (203) 430-1321 | |
| Not Available |
| Full Name | Revive Medical Group Ca Pc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 914 Pine St, Mount Shasta, California |
| Authorized Official Name and Position | Omar Ziyadeh (CEO/MANAGER) |
| Authorized Official Contact | 2034301321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Medical Group Ca Pc 81 Roanoke Ave Fairfield CT 06824-6124 Ph: (203) 430-1321 | Revive Medical Group Ca Pc 914 Pine St Mount Shasta CA 96067-2143 Ph: (203) 430-1321 |
| NPI Number | 1518724624 |
|---|---|
| Provider Enumeration Date | 03/05/2024 |
| Last Update Date | 03/05/2024 |
| Certification Date | 03/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518724624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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