Revive Salon and Spa
NPI #1619415072 in San Diego, California
Provider Information
- NPI Number
- 1619415072
- Entity Type
- Organization
- Organization Name
- Revive Salon and Spa
- Primary Specialty
- Nurse Practitioner - Family
- Enumeration Date
- Feb 6, 2017
- Last Updated
- Feb 6, 2017
Practice Location
- Address
- 5965 VILLAGE WAY
- Address 2
- E207
- City
- San Diego
- State
- California
- ZIP Code
- 92130-2475
- Phone
- (619) 293-7233
Authorized Official
- Name
- MARY LYNN ELIZABETH EICHERT, NP
- Title
- NURSE PRACTITIONER
- Phone
- (704) 516-6782
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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