| Revivamed Medical Corporation | |
|
711 4th Ave Suite 200 San Diego CA 92101-6970 | |
| (619) 232-3040 | |
| (619) 232-3041 |
| Full Name | Revivamed Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 711 4th Ave, San Diego, California |
| Authorized Official Name and Position | Roya Kohani (PRESIDENT) |
| Authorized Official Contact | 6192323040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revivamed Medical Corporation 711 4th Ave Suite 200 San Diego CA 92101-6970 Ph: (619) 232-3040 | Revivamed Medical Corporation 711 4th Ave Suite 200 San Diego CA 92101-6970 Ph: (619) 232-3040 |
| NPI Number | 1609061498 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 09/13/2007 |
| Medicare PECOS PAC ID | 2062684947 |
|---|---|
| Medicare Enrollment ID | O20111019000494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609061498 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A64593 (California) | Primary |
| 2086S0122X | Surgery - Plastic And Reconstructive Surgery | A50365 (California) | Secondary |
| Provider Name | Kian J Samimi |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1649213281 PECOS PAC ID: 4284638966 Enrollment ID: I20061130000230 |
Revivify Restorative Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16445 Bernardo Center Dr, San Diego, CA 92128 Phone: 858-429-0099 Fax: 858-676-1172 | |
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 | |
Aldiwani Medical Group Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11409 Windy Summit Pl, San Diego, CA 92127 Phone: 832-371-3279 Fax: 619-939-4556 | |
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 |