Revive Rejuvenation Center Anti Aging Regenerative Center INC
NPI #1588166094 in La Jolla, California
Provider Information
- NPI Number
- 1588166094
- Entity Type
- Organization
- Organization Name
- Revive Rejuvenation Center Anti Aging Regenerative Center INC
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Mar 1, 2018
- Last Updated
- Mar 21, 2018
Practice Location
- Address
- 7509 DRAPER AVE STE A
- City
- La Jolla
- State
- California
- ZIP Code
- 92037-4857
- Phone
- (858) 352-6200
Authorized Official
- Name
- MICHELLE GUTIERREZ
- Title
- CREDENTIALING SPECIALIST
- Phone
- (619) 501-6278
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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