| Revivify Restorative Medicine | |
|
16445 Bernardo Center Dr San Diego CA 92128-2523 | |
| (858) 429-0099 | |
| (858) 676-1172 |
| Full Name | Revivify Restorative Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 16445 Bernardo Center Dr, San Diego, California |
| Authorized Official Name and Position | Stephen M Daquino (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8584290099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revivify Restorative Medicine 16445 Bernardo Center Dr San Diego CA 92128-2523 Ph: (858) 429-0099 | Revivify Restorative Medicine 16445 Bernardo Center Dr San Diego CA 92128-2523 Ph: (858) 429-0099 |
| NPI Number | 1003164385 |
|---|---|
| Provider Enumeration Date | 08/17/2012 |
| Last Update Date | 07/29/2020 |
| Medicare PECOS PAC ID | 7416107149 |
|---|---|
| Medicare Enrollment ID | O20121015000655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003164385 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 20A8442 (California) | Primary |
| Provider Name | Stephen M Daquino |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1346351665 PECOS PAC ID: 8325009582 Enrollment ID: I20041020001345 |
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