| Clinica Revive Salud Pllc | |
|
6524 W Indian School Rd Ste A Phoenix AZ 85033-3329 | |
| (602) 892-0799 | |
| (602) 892-0828 |
| Full Name | Clinica Revive Salud Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6524 W Indian School Rd Ste A, Phoenix, Arizona |
| Authorized Official Name and Position | Nubia C Lomeli (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6028920799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Revive Salud Pllc 6524 W Indian School Rd Ste A Phoenix AZ 85033-3329 Ph: (602) 892-0799 | Clinica Revive Salud Pllc 6524 W Indian School Rd Ste A Phoenix AZ 85033-3329 Ph: (602) 892-0799 |
| NPI Number | 1750003323 |
|---|---|
| Provider Enumeration Date | 09/12/2022 |
| Last Update Date | 04/01/2024 |
| Medicare PECOS PAC ID | 3678938727 |
|---|---|
| Medicare Enrollment ID | O20230425002657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750003323 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Nubia Lomeli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619328374 PECOS PAC ID: 3971898875 Enrollment ID: I20160816002775 |
| Provider Name | Paula M Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316559289 PECOS PAC ID: 0143683979 Enrollment ID: I20230828001380 |
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